‘Doctors often ask for needless tests’

Durgesh Nandan Jha, TNN | Oct 6, 2012, 03.29AM IST

NEW DELHI: Here's a warning from a medical expert you won't get too often: Do not follow your doctor's prescriptions blindly and question whether you really need to undergo thediagnostic tests he or she asks for.

"On many occasions, doctors ask for tests that are unnecessary. Similarly, there are drugs that have become outdated or whose efficacy isn't proven. But doctors keep prescribing them. Unless there are standard guidelines on treatment of certain illnesses, such misuse will keep happening," said Dr Kameshwar Prasad, head of the clinical epidemiology unit at AIIMS.

With the number of cases involving unwarranted prescriptions of surgical procedures, diagnostic tests and medication increasing, Dr Prasad said patients must ask their doctor about the pros and cons of the treatment offered before making a decision.

To create awareness on the issue, AIIMS will hold an international meet — the first of its kind in the world — where experts will discuss how standard guidelines can be evolved for treating diseases.

Dr Prasad said unnecessary diagnostic tests and surgical procedures not just put additional financial burden but also affect the patient's recovery. "We are also proposing that evidence-based treatment methodologies should be emphasized in medical schools," he said.

AIIMS's neurology department recently screened prescriptions of 250 brain stroke patients referred from different hospitals.

Many drugs, operations prescribed without need

Doctors at AIIMS who recently screened prescriptions of 250 brain stroke patients referred from different hospitals said they found more than 48% of them were prescribed a particular drug which is not approved. "Either the doctor did not know about it or he used it despite knowing that it's not effective for the condition. In both cases, the patient had to suffer," the senior neurologist said.

Experts said among the most misused procedures were hysterectomy (uterus removal), caesarean section and angioplasty for artery blockage. Among drugs, the most commonly misused were vitamins, steroids and antioxidants. According to Dr Paul Glaszious, former director of Oxford University's Centre for Evidence-based Medicine, MRI and CT scan are also being overused. "Vertebroplasty - a spinal procedure where bone cement is injected into fractured vertebra - has proved to be ineffective in many studies. Still, it is being used as a treatment method in patients complaining of backache," he said.

In the case of angioplasties, experts said patients were most often not given time to decide whether they need to go for the procedure or not. For every patient with a blocked artery, there are three lines of treatment open - drug treatment, angioplasty and surgery.

A recent study in US show8ed that only 36% of patients who had undergone non-em8ergency angioplasty to clear a clogged artery actually met the criteria for the procedure. In 50% of the cases, there was not enough evidence to show angioplasty would help and in 14%, the procedure was definitely not required. The study was published recently in the Journal of the American College of Cardiology.

In the study, researchers gathered data from more than 24,000 angioplasty patients at 58 hospitals in New York State between 2009 and 2010, and measured how well the physicians stuck to the angioplasty guidelines advised by the American Heart Association and the American College of Cardiology.

Said Dr Ashok Seth, chairman, cardiovascular sciences division at the Fortis Escorts Heart Institute, "Emergency procedures are not required in most cases, except for conditions such asheart attacks and unstable angina (chest pain) where a patient has to undergo stenting or surgery within 12 hours. In my view, anybody who can walk 500 metres without chest pain or exertion can wait. Patients must think over seriously and weigh the benefits of medicine versus surgery versus angioplasty before saying yes to any one treatment."

"Every hospital should conduct an audit of various procedures carried out, say in a month. This would give us much-needed data about how prevalent each procedure is, and whether it is being misused," Dr Prasad said. He also urged patients to question their doctors constantly on their line of treatment and the tests prescribed by them.