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Thursday, May 17, 2012

Protect Your Kids from Overtesting

By Roy Benaroch, MD

Child Getting a Shot

True story: I saw a 2-year-old as a follow-up to his trip to the emergency room a few days previously. He was a healthy boy who developed vomiting and diarrhea, and his worried parents took him to the ER. There, a truckload of x-rays, blood tests, and stool tests were done. Among the pages of results were a few that were somewhat abnormal, so they kept him in the hospital for about ten hours and repeated them. They were still “abnormal”, but since the child had stopped having any symptoms—he was “running around, tearing up the place,” Dad said—they sent him home, to see me in a few days.

The tests, combined with radiologists’ fees, cost about $3,000. None of them helped the child, and none of them were necessary. In fact, they led to a prolongation of his ER stay (more money!), scared the parents, and ended up getting the poor child stuck with needles two more times.

What’s the harm in doing extra labs or x-rays?

  • They cost a lot. Patients may be upset to discover that they have a separate deductible for labwork—that money is going to come from somewhere.
  • Labs beget more labs. I can’t tell you how often kids need repeat labs just to confirm that an abnormal has become normal. If enough labwork is done, something is going to come up as “abnormal” in anyone. That doesn’t mean there is anything actually wrong with the patient.
  • Abnormal tests lead to unnecessary worry.
  • Drawing blood (and many other medical procedures) is painful, and will scare your child, and will make future health interactions difficult and upsetting.
  • Some tests (like x-rays) actually create problems—though the amount of radiation exposure is small, it can add up. About 1 to 3 out of 1000 cancers in the United States are actually caused by diagnostic radiation exposure.

There are, of course, times when labs and tests really are needed. For instance, a child with a fever and sore throat needs to have a strep test, because even a very experienced doctor cannot reliably distinguish between a viral and bacterial throat infection. It’s best to do the test first, so you treat the kids who genuinely need antibiotics correctly. Tests are needed when they help determine the best plan to help the child. But if the results of tests aren’t going to make any difference, the tests are not needed.

To help avoid the cost, hassle, and worry of excessive medical testing, keep these tips in mind:

  • Avoid going to the emergency room or urgent care centers. These places will do far more testing than your pediatrician or family doctor.
  • Don’t push for labwork. Labs should be not be done “just in case.” Unnecessary tests are much more likely to lead to mischief and misery than to anything medically important.
  • If labs or tests are suggested, ask what they’re for. How will they help? When will the results be back?
  • Know your insurance—how will labs be paid? Do you need to go to a specific “in-network” lab? Do you have a separate lab or radiology deductible or copay?
  • If testing is done, be sure to get copies of results for your pediatrician. Don’t accept “we’ll call you only if they’re abnormal.” If tests really needed to be done, then the results really need to be reviewed and kept in the record.
Photo: Fuse

Posted by: Roy Benaroch, MD, FAAP at 7:34 am

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