Medical Column: Ultrasound screening, another bad idea
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
When I saw a full-page ad in the local daily tabloid, I ignored it.
Then recently, I saw a personalized letter to my wife — “Dear Nancy, “What would your doctor say…if he/she could actually see inside your arteries?”
The enclosed brochure then asked, “Should you take these life saving tests? Don’t hesitate to ask your doctor.”
You asked, so…
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Dear XYZ Screening Company and Faithful Readers,
Thanks for your unsolicited letter to my wife. It provides a unique opportunity to educate Nancy and others about wholesale screening of healthy persons.
Your marketing promises safe and accurate ultrasound screening of carotid (neck) arteries, abdominal aneurysms, and arteries in the legs and feet, as well as testing for irregular heart rhythms and loss of bone salts (osteoporosis) — $60 per test or all for $149. Wow!
There are at least four solid reasons that your screening proposal is bad medicine.
First, your appeal is to create fear and anxiety.
Your mailing remarks, “You and your doctor can do something before it is too late” and “… since four out of five stroke victims had no apparent warning signs prior to stroke.”
Great medical care is predicated on shared decision making between patient and physician, based on solid evidence and patient preferences, not fear.
Second, you mention several times that Medicare and other insurers will not pay for your tests. The reason for their lack of coverage is that no professional organization recommends your tests when they are performed on healthy patients without symptoms. One exception is that the U.S. Preventative Services Task Force does recommend a one-time abdominal aortic aneurysm screening for men aged 65-75 who have ever smoked. The guidelines for osteoporosis screening are complicated. Talk to your doctor.
Third, screening tests performed on healthy persons consistently produce lots of false positives. That means that the test looks like you have something bad going on, when you are actually quite healthy. These falsely positive tests create worry and more costly tests to prove that you are healthy.
Fourth and finally, my personal experience with my patients is that the quality of testing performed by mobile “here today and gone tomorrow” companies does not approach that provided by the competent ultrasonographers in the permanent medical institutions in this community. I would not be reassured by “a normal test” from your company.
Please take Nancy’s name off your mailing list.
Phil Mohler, M.D.
P.S. Persons who have an extra $149 to spend: think Super Bowl paraphernalia! It is a better investment. Go Broncos!
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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