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March 28, 2011
I rarely get sick and have no known disease. I’m fit as a fiddle for an aging male. I jog four times a week and have strong vital signs (blood pressure is 120/70). I have no family history of heart disease.
Besides complying with adult screening recommendations and vaccines, I only see a doctor when I have a persistent cold or sore throat. I fear going to a doctor because the standard operating procedure in my area is to provide antibiotics before the results of a throat culture.
The last time I went to my doctor, I was concerned about a persistent cold I had after traveling to Asia. I was worried that I had picked up an exotic parasite or SARs infection. As I lay on the exam table, my primary care physician of over two decades said I should have an EKG. As a good and conscientious consumer, I questioned why. He replied that he needed to get a baseline test. Too sick and too tried to fight back, I reluctantly agreed to the test.
Since then I have learned that a baseline EKG yields little useful clinical information. In fact, the National Alliance of Physicians (NPA) — under a grant from the ABIM Foundation’s Putting the Charter Into Practice program — cites EKGs as tests that should be eliminated for asymptotic adults without a family history. EKGs were actually one of the NPA’s Five Things physicians should eliminate from their practice to improve quality and reduce costs.
This same primary care physician told another patient — and friend of mine — to have a stress test because he felt a woman turning 60 should have one. The findings from her stress test were not conclusive so he scheduled a cardiac catheterization. The results of the procedure showed no abnormality. However, my friend was left with an aching leg and a skin rash.
I have since sought a new primary care physician. It’s hard to break up with your physician but at least in this divorce no legal counsel was needed. My new physician knew of my previous physician’s propensity to overtreat – she had previously been in a practice with him.
In light of my unnecessary test, I am following the advice of Rosemary Gibson, author of Treatment Trap. Gibson suggests that clinicians and health professionals tell stories of care they received that were unnecessary, wasteful and the where the risks exceeded the benefits of the test or procedure.
Here’s mine. I hope you’ll share yours.
Daniel B. Wolfson
EVP and COO, ABIM Foundation