Report highlights needless medical tests

TORONTO — A new report suggests nearly a third of Canadian patients might be undergoing testing that’s not necessary to diagnose or treat their health conditions.

The study from the Canadian Institute for Health Information, published Thursday, examined eight specific types of treatment by drawing on data from across the country.

Based on that data, the institute says it estimates up to 30 per cent of low-risk patients are undergoing potentially needless medical tests.

The report was prepared in partnership with Choosing Wisely Canada, a clinician-led movement advocating for reductions in procedures that put a strain on the health care system and can lead to patient harm.

Since its inception two years ago, the CWC has identified about 200 areas in which they say patients are undergoing excessive or needless testing.

The Canadian Institute for Health Information says the report, coupled with CWC’s recommendations, should make patients reconsider the notion that more screening is always best.

“This kind of a report can give patients and clinicians an opportunity to ask, ‘do I really need this test? What are the downsides of it? Are there safer, simpler options? And what happens if I do nothing,” said Tracy Johnson, CIHI’s director of health systems, analysis and emerging issues.

The report examined eight kinds of tests for a variety of different health care settings, culling data from the provinces and analysing the results, Johnson said.

In one category, the study examined the number of patients who underwent some form of imaging in response to simple lower back pain. The CWC recommends people forego X-rays, MRI’s and CT Scans if they are experiencing lower back pain without any other symptoms.

Other categories the report looked at were the use of “atypical antipsychotics” among children and youth, reliance on types of drugs known as benzodiazepines among seniors as a treatment for insomnia, pre-operative tests conducted on patients undergoing low-risk surgery, mamography screenings among younger women at lower risk for breast cancer, imaging for minor head trauma, patients receiving blood transfusions in preparation for hip or knee replacement surgeries and those receiving CT scans if showing signs of delirium.

Johnson said a complex analysis of the categories, which make use of data sets from different provinces, suggests that an average of 30 per cent of patients will undergo tests that CWC advises against.

Johnson said the needless procedures increase wait times and put additional financial strain on the nation’s health care system, adding the institute has not yet determined exactly how much these additional procedures might cost.

The incoming head of the Canadian Medical Association welcomed the report, saying over-diagnosis is a rampant problem across Canada.

President-Elect Dr. Laurent Marcoux said patients are often the ones to request additional tests, but believes they are the ones who tend to suffer from their ill effects.

He said people who undergo needless X-rays, for instance, expose themselves to radiation, adding patients can also wind up on unnecessary medication that could have negative long-term effects.

Most pressing of all, he said, is the increased anxiety levels patients experience upon receiving test results for perceived conditions that are not causing problematic symptoms or manifesting themselves in any way.

A man undergoing an unnecessary test, for instance, may learn of abnormal cells in his prostate, he said. That man may go on to view himself as a potential cancer patient despite the fact that the cells may not make their presence felt for decades.

Marcoux questioned the medical climate that urges people to seek diagnoses as early as possible for ailments of all stripes.

“Our culture says ‘sooner is better,’” he said. “It’s not true. We think it’s better, but it’s not. Often it’s worse.”

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