{"id":33992,"date":"2015-04-24T11:02:26","date_gmt":"2015-04-24T10:02:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=33992"},"modified":"2015-04-24T11:02:26","modified_gmt":"2015-04-24T10:02:26","slug":"carlos-martins-overuse-of-medical-tests-a-new-health-risk-factor","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/04\/24\/carlos-martins-overuse-of-medical-tests-a-new-health-risk-factor\/","title":{"rendered":"Carlos Martins: Overuse of medical tests\u2014a new health risk factor?"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/04\/Carlos_Martins.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-33998\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/04\/Carlos_Martins-150x150.png\" alt=\"Carlos_Martins\" width=\"150\" height=\"150\" \/><\/a>A risk factor is, among other things, an aspect of personal behaviour or lifestyle that, on the\u00a0basis of epidemiologic evidence, is known to be associated with health related conditions\u00a0<span style=\"line-height: 1.5\">considered important to prevent (1).<\/span><\/p>\n<p>A new behaviour may be observed in the general population of western countries; a behaviour\u00a0related to the way patients use medical services with preventive intention and the frequency\u00a0that they receive medical tests and other screenings. Evidence shows an alarming tendency to\u00a0overuse preventive health services (2,3). In Portugal, for example, a recent population-based\u00a0cross-sectional study showed that the majority of Portuguese adults think they should undergo\u00a0general routine blood and urine tests on an annual basis. Other, even less-recommended\u00a0screening tests, such as lung X-rays, breast ultrasounds, abdominal ultrasounds, and\u00a0gynaecological ultrasounds, are deemed necessary by a great proportion of the population (3). <!--more--><\/p>\n<p>In part, this pattern of behaviour may be justified by the culturally rooted idea that routine\u00a0general health checks are necessary. Obtaining general health checks is a practice that is not\u00a0supported by the evidence because it does not reduce morbidity or mortality, neither overall\u00a0nor for cardiovascular or cancer-related illnesses, although they increase the number of new\u00a0diagnoses (4). Disease mongering campaigns, the greater variety and availability of medical\u00a0tests, and the disseminated notion that more medicine is always better may be other factors\u00a0that have contributed to the development of this behaviour. However, we should also consider\u00a0the hypothesis that medical consultation has moved from a paternalistic model to that which\u00a0we could call a consumeristic model. This is a kind of medical consultation where patients get\u00a0what they want, and which is quite different from the ideal shared decision making model.<\/p>\n<p>There is a growing amount of evidence that this behaviour is associated with harms, and those\u00a0harms are considered important to prevent. False positives, incidentalomas, being\u00a0overdiagnosed, and the resultant cascade of attitudes are some of those harms that may\u00a0significantly impair the quality of life of healthy people (5).<\/p>\n<p>Therefore, by definition, we may say that we are facing a new health risk factor: the excessive\u00a0and inappropriate use of medical tests. Of course, there is a dose of irony in this statement,\u00a0given that the excessive labelling of healthy people with &#8220;risk factors&#8221; has been one of the\u00a0main driving forces that has converted so many healthy individuals into patients (6). However,\u00a0it is quite probable that most people don&#8217;t know that they are at risk of suffering harm\u00a0when they undergo medical tests. If we think about the current state of the pharmaceutical\u00a0field, we all recognize that patients are aware of a potential drug&#8217;s adverse effects. But, most\u00a0of our patients have never heard of a medical test\u2019s possible adverse effects. Some patients\u00a0don\u2019t take a new medicine without first reading the Summary of Product Characteristics leaflet\u00a0included with the drug. Is now the right time to add some regulations to medical testing and\u00a0create a Summary of Test Characteristics? This may be a key communication tool in this area.\u00a0An adequately-structured instrument should have language accessible to the population, but\u00a0not necessarily as dense as the Summary of Product Characteristics. Sections such as\u00a0&#8220;indications,&#8221; &#8220;possible harms,&#8221; &#8220;predictive value according to the prevalence,&#8221; &#8220;number\u00a0needed to screen,&#8221; and &#8220;number needed to harm&#8221; could be included in this new Summary of\u00a0Test Characteristics. This is a suggestion that deserves an opportunity to be tested. Would it\u00a0have an impact on the way healthy patients view medical tests? This is an important question\u00a0<span style=\"line-height: 1.5\">to be answered using proper research.<\/span><\/p>\n<p>Nevertheless, if we want to prevent overdiagnosis and other potential harms related to\u00a0excessive, not evidence-based, use of medical tests by healthy people, we should start\u00a0designing strategies of communication to explain to our populations what is meant by\u00a0potential harms, false positives, and overdiagnosis. Only by understanding these meanings and\u00a0knowing the probabilities of being benefitted or harmed, will the patient be able to make a\u00a0shared decision and to avoid a consumeristic model of medical tests utilization.<\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.<\/em><\/p>\n<p><em><strong>Carlos Martins<\/strong>, Family Medicine Unit, Social Sciences and Health Department of the Faculty of<\/em><br \/>\n<em> Medicine of Porto.<br \/>\n<\/em><\/p>\n<p><strong>References:<\/strong><\/p>\n<p>1) International Epidemiological Association. <em>A dictionary of epidemiology<\/em> 4th ed. Oxford\u00a0University Press, 2001<br \/>\n2) Brotons C, Bulc M, Sammut MR, Sheehan M, Manuel da Silva Martins C, Bj\u00f6rkelund C et\u00a0al. <a href=\"http:\/\/fampra.oxfordjournals.org\/content\/29\/suppl_1\/i168.long\">Attitudes toward preventive services and lifestyle: the views of primary care patients in\u00a0Europe. The EUROPREVIEW patient study. <em>Fam Pract<\/em> 2012; Suppl 1:i168-i176<\/a>.<br \/>\n3) Martins C, Azevedo LF, Ribeiro O, Sa L, Santos P, Couto L, et al. <a href=\"http:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0081256\">A population-based\u00a0nationwide cross sectional study on preventive health services utilization in Portugal\u2014\u00a0What services (and frequencies) are deemed necessary by patients?<\/a> <em>PLoS\u00a0ONE<\/em> 2013;8:e81256.<br \/>\n4) Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, Gotzsche PC. <a href=\"http:\/\/www.bmj.com\/content\/345\/bmj.e7191\">General health checks in adults\u00a0for reducing morbidity and mortality from disease: Cochrane systematic review and metaanalysis<\/a>.\u00a0<em>BMJ<\/em> 2012;345:e7191<br \/>\n5) Welch HG. <em>Overdiagnosed: making people sick in the pursuit of health<\/em>. Beacon Press, 2011<br \/>\n6) Gervas J, Starfield B, Heath I. <a href=\"http:\/\/www.jhsph.edu\/research\/centers-and-institutes\/johns-hopkins-primary-care-policy-center\/publications_pdfs\/a237.pdf\">Is clinical prevention better than cure?<\/a> <em>Lancet<\/em>\u00a02008;372:1997\u20139<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A risk factor is, among other things, an aspect of personal behaviour or lifestyle that, on the\u00a0basis of epidemiologic evidence, is known to be associated with health related conditions\u00a0considered important [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/04\/24\/carlos-martins-overuse-of-medical-tests-a-new-health-risk-factor\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5756],"tags":[],"class_list":["post-33992","post","type-post","status-publish","format-standard","hentry","category-too-much-medicine"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Carlos Martins: Overuse of medical tests\u2014a new health risk factor? 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