Consider this. You walk into a doctor’s office and tell him that you simply want a routine medical check-up. What options does the doctor have? One, he takes a detailed clinical history, does a physical, and tells you that all’s well, you’re doing fine. Two, following the history taking and a physical, he asks you to undergo a battery of tests, which translate into another long day at the hospital and a large debit to your bank account, and yet, if the results are normal, you come out of the doctor’s office, grinning from ear to ear. Equally, you could feel that if all was well with you, why did the doctor order so many tests? Was he out just to rob you?
There’s also a fair chance that the tests end up yielding a slightly abnormal finding. That means further tests — maybe even a painful biopsy. You curse the doctor and the medical community saying that they’re out to fleece you. On the other hand, it’s just possible, that the “slight abnormal finding” might actually turn out be cancer, all discovered in good time!

sparking a lively debate
Indeed, the variables that drive decision-making in medicine today are simply far too many. Just as implicit faith and blind trust that governed patient-doctor relationships in the past era have been mired in bad tempers and law suits, today technology has swathed medicine like never before, and evidence based medicine has taken precedence over good clinical judgement. In fact healthcare has come under the increasing cloud of commerce, and the question of too many unnecessary and expensive tests has sparked many a lively debate.
People and policymakers often blame doctors for ordering far too many tests, and yet, doctors end up ordering tests since they do not wish to be charged with carelessness and face possible lawsuits later. Call it defensive medicine if you will! Yet the truth of the matter is that it is a hard road to walk.
There is no point wagging your finger at the doctor afterwards and telling him he shouldn’t have ordered that test. Instead, think if you can give any “prospective” examples of “unnecessary tests” that he should not order. Difficult to do? Perhaps, the answer lies in shared decision-making.

avoid unnecessary tests
Here are some tips on how to avoid the possibility of undergoing unnecessary tests:
Choose your doctor with care: Before choosing a medical doctor, talk to him/her and be sure you understand his philosophy about the use of medical tests. Make sure he welcomes open communication with you rather than simply ordering tests and prescribing medications.
Be as honest as possible: When you visit the doctor, be specific about your symptoms, but don’t self-diagnose. It’s the details you provide that minimise the need for extensive medical tests. Should the doctor ask, be honest about your diet and exercise habits. Don’t skimp on the details. If you find yourself in hospital again for something you were treated for in the past, let your doctor know what it was so that it may be ruled out if necessary.
Be frank: When a medical test is ordered, ask your doctor why he wants it done. He should be able to clarify the reason as well as what he’s looking for. If your doctor can’t give you this information, hold off on the test until you can get a second opinion.
Unnecessary tests can be hazardous: Some unnecessary medical tests have more serious consequences such as exposure to radiation. Each time you undergo an x-ray, you’re exposed to varying doses of ionising radiation. Even though the dose is small, the effect is cumulative and over time the damage to DNA, your genetic material adds up, increasing your risk of cancer.
This isn’t to say that x-rays and CT scans aren’t sometimes necessary. A doctor may have your best interests in mind when he orders an x-ray or CT because he doesn’t want to miss something serious.
Keep yourself informed: Be aware of what screening tests are likely to be useful for you, given your age, history, lifestyle and risks. For instance, if you’re under 45 years of age, a non-smoker, without a strong family history of heart disease and no cardiac-related complaints, a screening ECG is probably unnecessary whereas blood testing to check blood sugar and lipid levels is still appropriate. Keep informed and be aware. No one can protect your health better than you can.

The author is Senior Specialist, Safdarjung Hospital and Professor, VM Medical College and a
well-known columnist