Screening medical tests- desirable or distracting

To make an intelligent decision about your own screening, you need a physician who reviews your past and current medical history, your family history, and your health goals.

Both doctors and patients have mixed emotions about diagnostic tests done to screen for disease. We physicians want to help patients stay healthy, prevent disease, and treat problems early and effectively.But the time spent counselling, ordering, performing, and reviewing these tests means less time available to manage patients’existing medical problems.

I agree with Dr. William Zinn, family physician in Boston, who wrote

“Keeping track of the ever-increasing health maintenance requirements and cancer screening sometimes make it hard to remember why the patient came to the office in the first place.”

JAMA, January 7, 2020

For patients the issues are similar. While they want to stay healthy, prevent disease, and get treated promptly, they don’t like the inconvenience, time away from work, cost, and sometimes discomfort the tests require.

What are screening tests?

A screening medical test is done to uncover a disease or disorder in a person who may or may not be a risk for it and who otherwise feels well and has a normal exam. Suppose we are considering screening a group of people for disease X. Let’s start by dividing them into 3 groups.

  • Those with no symptoms, feel fine, at average risk of health condition X.
  • Those with no symptoms, feel fine, at increased or high risk of condition X.
  • Those who have symptoms suggestive of condition X, or have had other testing that suggests they might have it

Screening for X in groups 1 and 2 might be appropriate, based on medical guidelines, physician judgement, and patient preference. For group 3, with symptoms of condition X, testing would be considered diagnostic; a doctor would test for X, and possibly other conditions that the symptoms suggest.

Diagnostic vs Screening

That might seem like a picky difference, but there are several implications for both doctors and patients.

Documentation- The medical record needs to reflect accurately why a test is being ordered and done. This is necessary for billing because inaccurate coding can make doctors and clinics liable for fraud. Also, the government and other payers are starting to judge doctors’ quality of care based on medical record audits of care given or not given, and why.

Interpretation and Follow up-A test is rarely interpreted in isolation. The history and exam together with the test lead to a diagnosis.

Reimbursement– Most if not all insurances, including Medicare, reimburse differently based on whether a test is diagnostic or screening. And this usually determines how much the patient pays for each. Screening tests are usually covered 100% while diagnostic testing may require a deductible or copay .

A Country Doctor Writes blog explains this dilemma in detail –

But because in the inscrutable wisdom of the Obama Affordable Care Act, it was decided that screening colonoscopies done on people with no symptoms whatsoever are a freebie, whereas colonoscopies done when patients have symptoms of colon cancer are subject to severe financial penalties.

read more at this link

This link at FamilyDoctor.org helps explain how medical insurance coverage works.

Does disease screening make a difference?

Screening tests don’t prevent disease although they may be helpful for health maintenance or improvement. They may prevent progression or complications of a disease, but don’t prevent it’s onset. They may not even prevent death from the disease, although we like to believe they do. Screening may diagnose the disease before symptoms develop, so the patient lives longer with the disease, but not affect the eventual outcome.

So when should we offer screening tests?

If there is a clear benefit to patients from an effective treatment available to make a difference in the disease course or

If knowledge of the condition helps the patient and family make choices about managing the condition’s likely course or the need for family members to be screened

If the test is reliable enough to identify most people with the disease without falsely identifying people who don’t have it. The scientific terms for this are sensitivity and specificity.

When the benefits clearly outweigh the risks and costs.

How to decide for yourself

These are just some of the factors involved in deciding when to undergo screening tests. To make an intelligent decision about your own screening, you need a physician who reviews your past and current medical history, your family history, and your health goals. Then the doctor can make recommendations based on your needs and desires with the help of expert guidelines published by medical organizations who carefully review the medical literature.

Review the graphics in this post for recent guidelines from professional organizations and discuss with your physician. Help your doctor help you by scheduling a health maintenance visit rather than bringing it up when you are there sick or for chronic care. These discussions deserve your physician’s full attention.

further information from the National Institutes of Health.

To Screen or Not to Screen

¿Hacer o no hacer pruebas de detección?

exploring the HEART of health maintenance

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

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Less red meat + more vegetables = less cancer

The World Health Organization has officially classified red meat and processed meat as carcinogens-that is, likely to cause cancer if eaten regularly and recommends

“reducing consumption of these products (red and processed meats) to reduce the risk of colorectal cancer” .

WHO

Benefits of eating vegetables

In another post I shared some related information about diet and the risk of colon cancer – what is the risk of cancer in people who do not eat meat, or who eat very little?

cows in a field
American beef is popular

NEJM Journal Watch (New England Journal of Medicine) published this report in 2015.

“Vegetarian Diets Are Associated with Lower Risk for Colorectal Cancer”

In this North American prospective study, researchers identified the eating habits of 78,000 adults  for 7 years,   A prospective study means the people studied are followed or observed over a continuing period of time, usually years.

Participants followed one of five diets:

  1. Vegans: No eggs, dairy, fish, or meat
  2. Lacto-ovo vegetarians: Eggs and dairy, but no fish or meat
  3. Pescovegetarians: Eggs, dairy, and limited fish, but no meat
  4. Semivegetarians: eggs, dairy, and limited fish plus meat (≤1 time per week)
  5. Nonvegetarians: eggs, dairy, and fish plus meat (>1 time per week)
plate of vegetables
a meat free appetizer-hummus, cucumbers, crackers, and pita bread

results of the study

In that 7 years, 490  people developed colon cancer.

After adjusting for certain personal and clinical factors, they reported that all four vegetarian groups had a 22% lower risk of colon cancer than non vegetarians.

Most impressive was a 43% lower risk for the pescovegetarians.

They concluded that any diet in which fruit and vegetable intake is emphasized has health benefits, including lower risk for colon cancer.  And that eating fish in particular may be even more beneficial in regard to colon cancer.

Vegetarian diets are popular for various reasons, some related to health, some related to concern for animals or the environment.

 Besides cancer prevention, diets high in fruits and vegetables help to prevent and control

  • diabetes,
  • heart disease,
  • obesity, and
  • high blood pressure.

.

other resources

What the American Cancer Society says about diet and cancer.

More detail about the World Health Organization’s report on the link between red meat and cancer.

green leafy vegetables
Watercress and other greens are among the most nutritious vegetables.

Learn about Powerhouse Vegetables

sharing the HEART of staying healthy by eating

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

Here are some affiliate links you may find helpful. Thanks for considering and using, which helps me fund this blog’s mission-to share the HEART of health.

                              Dr. Aletha