There is a presumption in western culture that seeking information about our health is something that we all should do, says Joshua Barbour, an assistant professor of communication at Texas A&M University, in College Station.
It may seem like a given that more test results are better; that is not such a safe assumption to make. In fact, a growing number of experts now caution that the harm of some lab tests may outweigh the benefits.
Overuse and Overdiagnosed
James Goodwin, M.D., professor of internal medicine at the University of Texas Medical Branch, who studies overuse of cancer screenings. “That has been drilled into the American public. Physicians are part of the American public, so it has been drilled into us also.”
The message, he says, is overly simplistic. Newer research shows that cancer screenings are not always helpful. Despite longstanding recommendations that women receive annual mammograms beginnings at age 40, a large study published in the British Medical Journal found that annual screenings do not reduce the risk of death from breast cancer in low-risk women ages 40 to 59. An investigation conducted by Consumer Reports last year found that a variety of other cancer screenings is being overused as well.
Not only are lab test unnecessary in some cases, but they can cause real harm. According to Diana Petitti, M.D., a professor of biomedical informatics at Arizona State University, is the risk of a false positive diagnosis: a lab test shows cancer, but there isn’t any cancer in the person’s body.
Although false positives are a genuine concern, a more significant problem is the slightly different issue of overdiagnosis, which occurs when a lab test picks up cancer that is legitimate cancer but that would either go away on its own or would never cause symptoms within the patient’s lifetime.
The concept of overdiagnosis is a hard one to grasp, according to Goodwin, since it contradicts our common assumptions about the nature of cancer.
Although overdiagnosed cancers would be harmless, patients typically still receive treatment, and the treatments can produce serious health consequences. The prevailing attitude until very recently was that lab test cannot hurt, says Goodwin. “What’s become very, very clear over the past five years and perhaps longer than that is, no, it really can hurt.”
Evidence Based Medicine
Accuracy is critical during the diagnosis process. Evidence-based medicine depends on accurate assessment of information. Information accuracy is vital in decisions making used to develop diagnostic algorithms and clinical guidelines. Poor estimates of accuracy can contribute to mistreatment, increased costs, or patient injury. Therefore, the reliability of diagnosis depends on accurate information.
Lab tests “influence about 70 percent of medical decisions, for treatments big and small,” but Ellen Gabler, an investigative reporter, found that the private accrediting organizations that oversee medical labs “fail to cite serious violations,” so improperly calibrated machines, expired testing chemicals and blood, and other unsafe situations go unwatched and unpunished.
A recently enacted, Arizona law allows private citizens to get medical lab tests without a doctor’s orders. Critics of the law fear it will lead to over testing and diagnosis. Proponents of the law say it is in response to the consumer “on demand culture” where people can get what they want when they want it without waiting for a prescription. The law is aimed at fostering customers centered care.
Eighteen percent of the U.S. economy is spent on healthcare costs, and that amount is expected to escalate in coming years. This is all excess spending that does not produce a cure, a better outcome, or a more efficient system. The cost of this excess roughly $750 billion annually, numbers from the Institute of Medicine. Countries that spend far less on healthcare produce far better health outcomes than the U.S. system.
Experts believe that the problem exists because of individual healthcare (medical) insurance. For more information on healthcare (medical) insurance link to improved health data, review our article on “Obesity Epidemic was Mis-Managed“. Insurance protects us from paying the full cost of services while also insulating us from the full cost of those services. Providing incentives for providers to practice creative pricing.
Health Related Quality of Life
A lab test can provide a tool in the assessment and treatment of care, especially when the results are accurately diagnosed. Most people understand that more is not better, but if we are in fact living in a time of “on demand culture” consumer may ignore sound judgment. The problem could be that we have all seen too many T.V. program where one more test saves the patient’s life. In the real world, lab test can be harmful economically and for our health when used in excess. Imagine the psychological turmoil of a false positive cancer screen.
Medical insurance coverage alone does not improve health; it does guarantee escalating health care expenditures. Attempts at patient centered care should not create a system where abuses and overdiagnosis are built into the system. How do we increase health related quality of life (HRQoL) and improve autonomy for providers and consumers?
CFHE believes that collaboration is essential, specifically interprofessional collaboration. We are developing a scoring system designed to support primary and preventive care practitioners. The scoring system will allow consumers to be actively involved in the day to day management of their health and wellbeing. Providing users with a hands on approach to improving their HRQoL.
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In Arizona, no Doctor’s note needed for Blood Tests. (2015, August 5). http://hereandnow.wbur.org/2015/08/05/arizona-blood-tests
Investigations show required Blood Tests slow others dangerously flawed. (2015, December 30). https://hereandnow.wbur.org/2015/12/30/blood-tests-milwaukee-journal-sentinel
Health Economist: Problem with care is it insulates me from prices. (2013, January 2). http://hereandnow.wbur.org/2013/01/02/excess-medical-spending