8 Times It’s Okay to Question Your Doctor’s Advice
It’s natural to just say yes to medical tests, but more screening is not always better for your health. If any of these situations come up, consider a longer conversation.
Chances are you’re fairly comfortable in your role as patient: You come prepared with questions, downplay the hours you spent Googling symptoms, and listen carefully to any next steps. But how practiced are you at questioning doctor’s orders when it comes to tests and procedures?
Not only are some tests unnecessary, but they can point a physician toward the wrong diagnosis, cause undue stress and cost, lead to further unnecessary testing, and even make your health condition worse. “Almost every test has some degree of risk,” cautions Joshua Kosowsky, MD, coauthor of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Quite often, a diagnosis can be made based solely on a physical examination and a patient’s history, says Brandon Combs, MD, associate professor of medicine at the University of Colorado School of Medicine and a senior fellow for medical education at the Lown Institute, an organization that works to make health care more personalized. Even though unnecessary tests can be harmless, discussions about them can eat up valuable appointment time that might be better spent addressing issues that have a major impact on your physical health, such as diet or smoking, or your mental health, says Combs.
The tests here are ones that you simply may not need or that may carry more risks than benefits. If your medical professional suggests one, you should feel comfortable asking some follow-ups.
1 Question It: Imaging for First-Time Lower-Back Pain
Why It May Be Unnecessary: If this is your first time wrenching your lower back, imaging might not reveal the cause—and could complicate treatment. “If you take 100 random people and do an MRI [magnetic resonance imaging] of their lumbar spine, a number of people without pain will show the same abnormal findings as those with pain,” says Max Wintermark, MD, chief of neuroradiology at Stanford University. (One study found that 81 percent of adults with no symptoms showed a bulging disk.) Finding an abnormality doesn’t mean it’s the source of the pain, and treating based on scan results might lead a patient down a road of potentially unhelpful interventions, including surgery. At best, imaging results likely won’t change the treatment recommendation: In many instances, doctors will prescribe physical therapy no matter what a scan reveals.
What to Try Instead: A combination of rest, anti-inflammatory medication, and physical therapy for six weeks. Revisit the option of imaging only if pain has not improved.
When to Say Yes: If you have red flags such as numbness or osteoporosis, imaging may be necessary. “In that case, an X-ray is often done first,” says Wintermark. If more complicated imaging is required, your doctor may decide between an MRI, which reveals soft-tissue or ligament damage, and a CT (computed tomography) scan, which is better at revealing bone issues.
2 Question It: Annual or Biannual Dental X-rays
Why It May Be Unnecessary: All dental X-rays involve ionizing radiation, which can increase the risk of thyroid cancer, “although the risk is still quite low,” says Charles Emerson, MD, president-elect of the American Thyroid Association. But while the dose and risk are small, a recent study found that the more dental X-rays a person had, the more likely she was to develop a meningioma, a brain tumor that can lead to vision changes and seizures. Bottom line: You don’t want unnecessary radiation exposure. That’s why the revised guidelines from the American Dental Association (ADA) state that if you’ve had no evidence of decay or gum disease for several years, you can go two to three years between bitewing X-rays (images of the lower and upper crown teeth), since that’s about how long it takes for cavities to progress, says Sharon Brooks, DDS, a spokesperson for the ADA.
What to Try Instead: Visit your dentist every six months to a year for a cleaning and oral examination. If she detects evidence of decay or gum disease and wants to do X-rays, ask about digital X-rays, which reduce the amount of radiation exposure by 40 to 60 percent compared with the film type.
When to Say Yes: You may need bitewing X-rays more often if you have swelling or pain or are on medication that produces a dry mouth. (Saliva is good for your teeth because it neutralizes cavity-causing acid.)
3 Question It: Annual Pap Smear
Why It May Be Unnecessary: For decades, teens and women were advised to get an annual Pap smear, a lab test that looks for atypical cervical cells that could become cancerous. In 2013, the American College of Obstetricians and Gynecologists (ACOG) changed that recommendation. “We have a much better understanding of cervical cancer than we did when the test was developed in the 1950s,” says Barbara Levy, MD, ACOG’s vice president for health policy. Experts now know that cervical cancer takes 5 to 10 years to develop, so getting tested every few years should catch new growth in plenty of time.
What to Try Instead: All women should visit their ob-gyn yearly for a well-woman visit, which may include pelvic and breast exams. Women ages 21 to 29 should have a Pap smear every three years; women ages 30 to 65 should schedule a Pap smear and a test for HPV (human papillomavirus, which causes most cervical cancer) every five years, or a Pap smear alone every three years.
When to Say Yes: If you’ve switched doctors and can’t recall the date of your last Pap smear, your new doctor may decide to do one to be safe. And you may need more frequent Pap screenings if you have a history of cervical cancer or a weakened immune system.
4 Question It: A CT Scan for Headache or Mild Head Trauma
Why It May Be Unnecessary: While CT scans of the brain can reveal a lot—whether you have bleeding or a stroke risk, for example—mild headaches, fainting spells, and mild head injuries don’t necessitate a CT scan. It’s worth being cautious, because one brain CT delivers a radiation dose equal to eight months of background exposure (the daily exposure we all get from the sun, soil, rocks, and other things in our environment).
What to Try Instead: Doctors can often rule out serious injuries and conditions by doing a thorough neurological examination and getting a full medical history.
When to Say Yes: You’ll want to be especially wary if you have any of these symptoms: confusion, vomiting, or unconsciousness. If you do, an imaging test may be necessary, says Wintermark.
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5 Question It: FSH Test to Diagnose Perimenopause
Why It May Be Unnecessary: The test doesn’t accurately indicate whether you’ve entered perimen-opause, the years during which your ovaries gradually stop producing estrogen. Though FSH (follicle-stimulating hormone) levels do rise when estrogen goes down, they vary on a day-to-day basis in women of all ages, so you could get a false positive or negative. Levy cuts to the chase: “It’s a completely meaningless test for perimenopause.”
What to Try Instead: Doctors can make a more accurate diagnosis by tracking your period frequency and length and watching for hormonally triggered symptoms, such as headaches, insomnia, hot flashes, mood swings, and sleep difficulties.
When to Say Yes: Your doctor may determine that repeated FSH testing is helpful to assess fertility if you’re trying to get pregnant, or to diagnose ovarian cysts or polycystic ovary syndrome.
6 Question It: Ultrasound to Screen for Ovarian Cancer
Why It May Be Unnecessary: Ultrasound screenings in healthy women can show “abnormalities“ that turn out to be normal, subjecting women to unnecessary biopsies. “Ovaries make cysts for a living; it’s their job,” says Levy, who notes that your doctor may see a number of what turn out to be benign cysts on routine ultrasounds. (Biology class refresher: The follicle that produces the egg is actually a type of cyst, and sometimes the cysts continue growing, only to burst on their own after a few weeks.) Unfortunately, research shows that annual ultrasound screening does not reduce the risk of dying from ovarian cancer.
What to Try Instead: It’s frustrating that no good screening test for ovarian cancer exists yet. If symptoms such as bloating, abdominal pain, feeling full quickly after eating, and urinary urgency persist or worsen, see your doctor.
When to Say Yes: If your doctor notices an abnormality in your cervix or uterus or that you have an irregularly shaped uterus, she may do an ultrasound, says Christopher Zahn, MD, vice president of practice activities for ACOG. Ditto if you have unexplained weight loss or gain, experience symptoms like those mentioned above, or are at high risk because of family history or a BRCA mutation.
7 Question It: Yearly Vitamin D Test
Why It May Be Unnecessary: Certain people are at high risk of a deficiency, such as those who are obese or have dark skin. For everyone else, there’s not enough evidence that checking levels and taking supplements makes healthy people any healthier, according to the U.S. Preventive Services Task Force. “Vitamin D is essential for bone health, among other things,” says Combs. “But in a person who feels well, research has shown that supplementing does not improve health, lead to fewer fractures, or help the person live longer.”
What to Try Instead: Eat more D-fortified dairy, soy products, cereal, fatty fish, and leafy greens.
When to Say Yes: If you’re pregnant or at risk of osteoporosis, your doctor may want to test your levels and prescribe supplements.
8 Question It: Annual CBC and Cholesterol Test
Why It May Be Unnecessary: If you’re healthy, feel well, and don’t have new symptoms, there’s typically no reason to get these tests yearly, says Combs. CBCs (complete blood counts) show the number of white and red blood cells and platelets, and in healthy people there’s rarely any meaningful change. The same goes for cholesterol. “Women who have an average risk of heart disease could get a baseline cholesterol check at 35, but the goal of the test is to gauge the risk of heart attack over the next 10 years,” says Combs. “If your levels are normal, they likely won’t change in a year or two.”
What to Try Instead: Talk to your doctor about your risk of heart disease and how you can lower it. Your weight, diet, and exercise habits all play a big role, and stress may affect your heart, too.
When to Say Yes: For patients undergoing cancer treatment or with weakened immune systems, CBCs may be done periodically to check for infection. In addition, if you have symptoms of anemia (weakness, excessive bruising), a CBC can confirm or rule that out.