Before you jump in…Re-thinking preventive health screening

deep-endAn advertisement arrived in my mail recently from a local hospital system offering a special promotion on  “heart disease, stroke, and aneurysm prevention package testing.” The tests included were extensive, and the mailing screamed not to wait to schedule these “life-saving screenings.” And, by the way, these tests are normally valued at over $2100 but were offered through this promotion for the low, low price of $179.00! My doctor has never mentioned most of these tests to me, but I found myself wondering about the state of my arteries and heart and whether having these tests might not be a good idea.

I mean, $2100 of tests for $179 – what a value!

Or is it?

There was one little thing this advertisement didn’t mention: What are the risks and costs if I have these tests?

The 6 tests that were offered were an echocardiogram, an abdominal aortic ultrasound, a peripheral arterial disease test, a carotid artery ultrasound, an EKG, and a bone density test.

If some, or all of these tests are unfamiliar to you and you’re like me, your doctor hasn’t recommended them for you, that might be a clue that these are tests that aren’t done routinely for the general public, at any price.

The US Preventive Services Task Force is an independent panel of non-Federal experts in prevention and evidence-based medicine. This multi-specialty panel is responsible for reviewing the evidence, and lots of it, and making recommendations for preventive care. For the USPSTF to recommend a particular service they note “…. the benefits of the service must outweigh the harms.” Harms? Screening tests can cause harm? You bet they can.

How?

Let’s look at the USPSTF recommendation for the carotid artery ultrasound test. The  recommendation states: “The USPSTF recommends against screening for asymptomatic (not having symptoms) carotid artery stenosis (narrowing) in the general adult population.”

While ultrasound itself rarely causes harm, it also isn’t like viewing an HD TV picture. That means if the image shows anything out of the ordinary it can’t necessarily tell exactly what it is. The USPSTF notes that the follow up tests for carotid artery ultrasound also can’t confirm with high degree of accuracy what’s actually there. Surgery may be the only way to really see what’s going on, and the surgery to explore a carotid artery stenosis has a high incidence of complications, including stroke itself.

Most of the other tests in this panel have similar recommendations.  They’re recommended only when you have risk factors or symptoms because the risks of having the test itself outweigh the potential benefits.

So in the absence of risk factors or symptoms, a $179 battery of tests has the potential to result in additional tests at more cost, risk of harm from more invasive tests, and maybe even an unnecessary and risky surgery, not to mention the personal stress of going through all this.

Once you jump into the deep end of this pool of screening tests you may not really need, getting out, whether you swim to the other end or try to go up the ladder can be pretty tricky.

If you have risk factors, or your doctor has recommended these screening tests to you for other reasons, this might be a great way to get some lower cost testing done, if you have  $179 to pay for it out of your own pocket.

But here’s the real question:  Why would a healthcare system be paying to mail flyers offering these tests to anyone in the general public? There’s a clue in the small print:

“If an abnormality is discovered, a professional staff member from (the healthcare system) may follow up with you to discuss your options.” (italics mine.)

There are only two options: 1) follow up, or 2) to ignore the results. A certain percentage of people who will elect this kind of testing won’t have a physician to follow up with. Pardon my cynicism, but what a great way to recruit new patients and generate some revenue for a hospital! And if you do have a physician, and you share these results with him or her, you’ve left her/him with little recourse but to order further tests or procedures to confirm or refute those results.

I’m not saying preventive screening tests are a bad idea – what I am saying though is be informed. Don’t jump into the pool until you know how deep it is. And if you’d like a lighter approach to this topic, don’t miss this from Choosing Wisely.

What can an informed patient consumer do?

1)   I am a big advocate for patient consumers taking an active role in managing their health. But when we undertake responsibility for these kinds of tests without involving our health care providers in that decision or really understanding the risks and benefits, we may unsuspectingly create more problems than we solve.

2)   Understand all screening tests have risks. There is the risk of the test itself, and the risk of a false positive (a positive test result that’s really nothing) or a false negative (an all clear that really isn’t) and follow up that might be required to be sure.

3)   If a screening or preventive test is recommended for you:

a. Always ask what the risks are both of having as well as not having a screening test done.

b. Check the USPSTF website and see what their recommendations are for any screening tests you’re considering or that’s been recommended to you. If you aren’t sure how to interpret their recommendations, call your doctor or a private patient advocate to discuss.

c. Before any screening test discuss with your doctor or healthcare provider what happens if a test result is positive.

d. Not all preventive screening tests are covered by insurance. Make sure you have a ballpark idea of what a recommended screening test will cost you out of your own pocket. Your health insurance provider or a private patient advocate can help you with this.

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