Every day we hear stories about rare conditions miraculously detected or treated with the latest medical advances. It might make it hard to believe that sometimes doing less can actually keep us healthier.
"With thousands of tests available, physicians run the risk of developing medical attention deficit disorder, focusing on test numbers rather than the big picture," says Steven Rothschild, MD, a family medicine specialist at Rush University Medical Center. "At the same time, patients may not realize there are times they'd be better off (in the long run) not having a test or procedure."
Here, Rothschild suggests some instances in which you might consider following a more conservative approach to care.
Why are doctors prescribing antibiotics less often?
Even if someone has congestion, a cough, a runny nose or a sinus infection for up to two weeks, they are unlikely to benefit from antibiotics. New guidelines even point out that children don't need antibiotics for every ear infection. Treatments come with a risk; any time we use antibiotics inappropriately, we increase the pool of resistant germs in our population. Most recently, we've seen the emergence of drug-resistant organisms — the best known being methicillin-resistant Staphylococcus aureus, or MRSA.
Of course, there is still a place for antibiotics. For instance, it is appropriate to use them to treat bacterial infections such as strep throat or bladder or staph infections.
How should you address back pain?
Most acute low-back strains will get better on their own regardless of what you do. In fact, studies have shown there is no difference in recovery time if someone with new back pain starts physical therapy or chiropractic intervention or goes on strict bedrest. However, these options — along with rest and anti-inflammatory medication — can provide short-term relief.
X-rays and MRIs are not always necessary early on with back pain. That's because these tests may find abnormalities, such as a small herniated disc, that are not the actual cause of pain. These findings can then lead to more invasive tests that carry greater risks. However, for back pain that is accompanied by neurologic symptoms (for example, numbness) or lasts longer than six weeks, you may need the tests.
Are electrocardiograms (EKG) necessary in routine check-ups?
An EKG is a test that records the electrical activity of the heart and is used to measure any damage to the heart; how fast your heart is beating and whether it is beating normally; the effects of drugs or devices used to control the heart; and the size and position of your heart chambers.
EKGs can show us a lot of information, and there is a place for them. Someone with chest pain, shortness of breath, irregular heartbeat or palpitations absolutely needs an EKG. In the past, EKG was often part of routine physicals, especially in older patients.
However, over the years, several groups, including the U.S. Preventive Services Task Force, have recommended against routine EKGs to assess the risk of heart disease in people who do not have any symptoms of heart disease. There is no evidence that a “routine” annual EKG will make a difference or help these people. It is unfortunate because heart disease is the number one killer in the United States, and it would be great if we had a reliable test for heart disease. But EKG is not it.
The biggest risk with an EKG is that any abnormality will lead to further testing, like an angiogram (a minimally invasive procedure that determines how blood flows through the arteries in your heart). Although the risks are rare — and incredibly rare at a place like Rush — risks with an angiogram include injury to the heart arteries, irregular heartbeats, stroke or heart attack.
Whether or not a patient needs an EKG depends on the individual's symptoms and their risk for heart disease. Assessing each patient's history and symptoms allows me to determine if he or she needs the test in the first place.
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