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9 UNEXPECTED CONSEQUENCES OF ROUTINE MEDICAL TESTS · Your Daily Dose

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  Speaker 1: You know, I guess I like to use my cousin
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  Speaker 1: as an example about how improper medical care can create
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  Speaker 1: a lot of problems in your life.
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  Speaker 2: They do testing.
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  Speaker 1: They come up with some concepts and then they just
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  Speaker 1: leave them out there to dry. And he's struggling right now.
• 0:20
  Speaker 1: So a new study comes out saying there's a problem
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  Speaker 1: in the medical world. And we're starting to find unexpected
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  Speaker 1: consequences of some of these routine tests that doctors don't
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  Speaker 1: really understand, and they don't really do anything with. So
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  Speaker 1: nine unexpected consequences of routine medical tests.
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  Speaker 2: Stay tuned.
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  Speaker 3: Hi, and welcome to Health Talk with Dr. Len, your
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  Speaker 3: daily dose. The information you hear on this show is informational.
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  Speaker 3: It's not meant to diagnose or treat any disease.
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  Speaker 1: Any kind of complete health conditions must be checked out
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  Speaker 1: and discussed with your primary care physician.
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  Speaker 3: Get ready for the good news of the day. God
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  Speaker 3: bless you folks, and here is Dr. Lent.
• 1:04
  Speaker 1: And here's our good news for the day, coming from
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  Speaker 1: the book of James chapter 1. Be prepared to suffer
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  Speaker 1: for me in my name. All suffering has meaning in
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  Speaker 1: my kingdom. Pain and problems are opportunities to demonstrate your
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  Speaker 1: trust in me. Bearing your circumstances bravely, even thanking me
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  Speaker 1: for them, is one of the highest forms of praise.
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  Speaker 1: The sacrifice of thanksgiving rings golden-toned bells of joy throughout
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  Speaker 1: the heavenly realms. On earth also, your patient suffering sends
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  Speaker 1: out ripples of good tidings in ever-widening circles. When suffering strikes,
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  Speaker 1: remember that I am sovereign and that I can bring
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  Speaker 1: good out of everything.
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  Speaker 2: Don't try to run from pain or hide from problems.
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  Speaker 1: Instead, accept adversity in my name, offering it to me
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  Speaker 1: for my purposes. Thus, your suffering gains meaning and draws
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  Speaker 1: you closer to me. Joy emerges from the ashes of
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  Speaker 1: adversity through your trust and thankfulness.
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  Speaker 2: Stay tuned.
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  Speaker 3: 727-916-4215.
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  Speaker 2: Rich was about 77.
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  Speaker 1: Years old, feeling fine.
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  Speaker 2: When his doctor suggested a heart scan.
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  Speaker 1: His father died many years prior to a heart attack
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  Speaker 1: at age 38, so he agreed.
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  Speaker 2: The scan found lots of calcium in his arteries. A
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  Speaker 2: follow-up stress test then came back normal. Over the years,
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  Speaker 2: so did another one.
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  Speaker 1: When a third one hinted at a slight blockage, the
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  Speaker 1: doctor offered a catheterization with threads of thin tube into
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  Speaker 1: the heart's arteries. Rich declined, worried it might lead to
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  Speaker 1: a stint and blood thinners. Cardiologist he consulted agreed and
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  Speaker 1: said he.
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  Speaker 2: Wouldn't do it either. Primary care, yes. Cardiologist, no.
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  Speaker 1: His heart history goes back almost 30 years. Rich had
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  Speaker 1: a heart attack 30 years ago. He needed a procedure
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  Speaker 1: to open up his arteries back then. And this scan
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  Speaker 1: that he just did will cost him. For years, it
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  Speaker 1: limited his health insurance options and pushed his premiums to $ 2, 300.
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  Speaker 2: Per month, even though he's on Medicare.
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  Speaker 1: Medical tests can be life-saving, but few patients are ever
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  Speaker 1: told how accurate they actually are, what expected scenarios commonly unfold,
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  Speaker 1: or how they prepare themselves for the problems tests can bring.
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  Speaker 2: Here are nine things everyone should know about tests.
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  Speaker 1: Number one, a single test can lead to up to
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  Speaker 1: five more A routine test can seem harmless, even responsible.
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  Speaker 1: Your doctor recommends it, your neighbor just had one. However,
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  Speaker 1: testos don't always end up with one clear answer. Sometimes
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  Speaker 1: the result leads to another test, and another, and another,
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  Speaker 1: and another.
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  Speaker 3: Dr.
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  Speaker 1: Ishani, a primary care physician and researcher at Harvard Medical School,
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  Speaker 1: summed it up with a joke. If you give a
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  Speaker 1: mouse an EKG, it's a rift on the children's book.
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  Speaker 1: If you give a mouse a cookie, in which a
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  Speaker 1: cookie leads to a glass of milk, the milk leads
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  Speaker 1: to a straw, and it goes on. Doctors call it
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  Speaker 1: a cascade of care. In a 2019 national survey, U.S. internists,
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  Speaker 1: 99% of them said they had spotted something while looking
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  Speaker 1: for something else. An incidental finding. These findings then triggered
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  Speaker 1: follow-up tests and procedures. More than 94% had seen a
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  Speaker 1: cascade that ultimately found nothing that needed treatment.
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  Speaker 2: Dr.
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  Speaker 1: Ganguly studied one common example, routine EKGs before cataract surgery,
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  Speaker 1: a quick and low-risk eye operation. Guidelines say a routine
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  Speaker 1: EKG before surgeries don't make it any safer.
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  Speaker 2: Many patients get it anyway.
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  Speaker 1: Ganguly's team looked at more than 110,000 Medicare patients with
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  Speaker 1: no known heart disease. Of those who had an EKG,
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  Speaker 1: about one in six went on to see a heart
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  Speaker 1: doctor or have more tests for the next three months
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  Speaker 1: for symptoms such.
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  Speaker 2: As Slightly low heartbeat.
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  Speaker 1: EKGs cost Medicare in this case $ 3.
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  Speaker 2: 3 million.
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  Speaker 1: The follow-up care estimated at $ 35 million. The researchers acknowledged
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  Speaker 1: that some of the care may have helped some people.
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  Speaker 1: On average, though, they said such cascades can cause worry
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  Speaker 1: and lead to care patients may not have needed. If
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  Speaker 1: a test isn't needed, why do doctors keep ordering it?
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  Speaker 1: I think the answer is fear, said Dr. Gilbert Welsh,
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  Speaker 1: a general internist, co-author of a book called Overdiagnosing, Making
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  Speaker 1: People Sick in the Pursuit of Health. Doctors don't want
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  Speaker 1: to be sued, and they don't want to be the
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  Speaker 1: one who missed something. Some patients also want a definitive answer,
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  Speaker 1: even though no test can ever truly give one. Fear
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  Speaker 1: can keep the cascade going, but you can stop it
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  Speaker 1: at any time. One way to do that is ask
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  Speaker 1: your doctor what other test will tell you that you
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  Speaker 1: don't already know, or what will change about your treatment protocols.
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  Speaker 1: Number two, a test can sound a false alarm.
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  Speaker 2: A scan may say you have cancer, the next says
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  Speaker 2: you don't.
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  Speaker 1: First test was a false positive, common in many routine screenings.
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  Speaker 1: Many people get screened feeling fine and don't have a
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  Speaker 1: disease in question. But every test occasionally flags a healthy
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  Speaker 1: person by mistake. Because healthy people far outnumber sick ones,
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  Speaker 1: those mistakes add up. So when a screening test comes
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  Speaker 1: back positive, it's often a false alarm. In the National
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  Speaker 1: Lung Screening Trial, one in four low-dose CT scans came
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  Speaker 1: back positive. More than 96% of those results turned out
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  Speaker 1: not to be anything, including not being cancer. Number three,
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  Speaker 1: tests seem to find inconsequential disease. Tests are good at
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  Speaker 1: finding things, even things that don't matter. The problem is
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  Speaker 1: it's often unclear which findings matter, and sorting that out
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  Speaker 1: can mean a grueling round of more tests. Unlike false positives,
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  Speaker 1: the test didn't make a mistake, the disease is real,
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  Speaker 1: but never would have made you sick or shortened your life.
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  Speaker 1: With prostate cancer, as with many cancers, doctors often can't
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  Speaker 1: tell which cancer will stay quiet and which will turn dangerous.
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  Speaker 1: So a man may end up with repeated biopsies or surgeries,
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  Speaker 1: or is simply living noting that there's Still some changes
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  Speaker 1: in their good treatment for cancer that never would have
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  Speaker 1: harmed them because there's no reliable way of knowing in
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  Speaker 1: advance which one would stay quiet. The disease helps only
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  Speaker 1: if catching the disease early keeps you from getting sick
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  Speaker 1: or dying later. If it doesn't, you take on the
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  Speaker 1: worry and the bills without benefit. Number four, tests can
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  Speaker 1: turn you into a patient. Your blood sugar is a
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  Speaker 1: couple points too high. Your cholesterol is just out of
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  Speaker 1: the normal range. You feel the same as yesterday, but
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  Speaker 1: now your chart says abnormal. Medical tests make it easier
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  Speaker 1: than you might think to go from being a healthy
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  Speaker 1: adult to being a patient. Wells sees it in his
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  Speaker 1: own patient portal. Results often carry a yellow abnormal tag.
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  Speaker 1: Even this high-density lipoprotein cholesterol, the good cholesterol, is flagged
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  Speaker 1: for being too high. Well, she understands the nuances that
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  Speaker 1: the biochemistry involves and finds it laughable. A patient may not,
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  Speaker 1: he said, especially when the results arrive with no doctor
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  Speaker 1: there to explain it to them. He worries more when
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  Speaker 1: a number comes back and becomes a label such as prediabetes.
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  Speaker 1: In older adults, he said, overreacting to that label could
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  Speaker 1: lead to medications that.
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  Speaker 2: Do more harm than good.
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  Speaker 1: A 2021 study published in JAM Internal Medicine followed more
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  Speaker 1: than 3,400 people in their 70s and 80s without diabetes.
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  Speaker 1: Some had blood sugars that were a bit high, what
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  Speaker 1: doctors would call prediabetes. About five years later, less than
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  Speaker 1: 1 in 10 had diabetes. More returned to normal blood
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  Speaker 1: sugar or died first. In this age group, the researchers
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  Speaker 1: wrote pre-diabetes may be a poor predictor of diabetes.
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  Speaker 2: Number five, a test can plant an unshakable worry.
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  Speaker 1: A test can uncover something that you were never looking for,
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  Speaker 1: and once you know it's there, you can't stop worrying
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  Speaker 1: about it, and that's where my cousin is now. A
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  Speaker 1: heart scan, for example, finds a spot on the lungs.
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  Speaker 1: Is it cancer or just a scar from an old infection?
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  Speaker 1: Look what's going on with the pope right now. A
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  Speaker 1: simple scan found what they said was just a minor
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  Speaker 1: growth that.
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  Speaker 2: Ended up being lung cancer.
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  Speaker 1: Most spots such as this turn out to be harmless,
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  Speaker 1: but it's hard to say from a picture. Now you
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  Speaker 1: and your doctor need to decide what to do next,
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  Speaker 1: and your worry had just begun. Radiologists call these incidental findings,
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  Speaker 1: and they're common. A 2018 review published in a British
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  Speaker 1: medical journal said they chose up 45% of chest CT scans.
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  Speaker 2: Number six.
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  Speaker 1: The test itself can hurt you. It's easy to look
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  Speaker 1: at a test as a simple way to look inside
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  Speaker 1: the body. Sometimes it is. However, every test, no matter
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  Speaker 1: how simple, carries physical risks. CT scan, for example, uses
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  Speaker 1: far more radiation than the standard x-ray. A 2025 study
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  Speaker 1: published in JAMA Internal Medicine found that CT scans conducted
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  Speaker 1: in the United States in 2023 were projected to result
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  Speaker 1: in 103,000 cancers. If nothing changes, the researchers estimated, those
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  Speaker 1: cancers could account for 5% of new diagnoses each year.
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  Speaker 1: Families should have no fear about a needed CT scan,
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  Speaker 1: but should have a concern about avoidable CT scans.
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  Speaker 2: Procedures carry their own dangers.
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  Speaker 1: For every 10,000 screenings of colonoscopies, nearly 15 cause major
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  Speaker 1: bleeding and 3 tear the bowel. The risk rises with age.
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  Speaker 1: A prostate biopsy, the usual step after a high PSA,
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  Speaker 1: Sends about 1 in 100 men to the hospital, usually
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  Speaker 1: with an infection. Number seven, the test can cost more
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  Speaker 1: than money. Many screening tests are free. What follows often isn't,
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  Speaker 1: and the bill is only part of the cost. Under
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  Speaker 1: the Affordable Care Act, most plans cover screening mammograms at
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  Speaker 1: no cost, but not necessarily the extra imaging and biopsy
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  Speaker 1: after an abnormal result. A 2025 analysis by the American
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  Speaker 1: Cancer Society Cancer Action Network, more than 70% of insured
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  Speaker 1: women who needed a follow-up imaging paid out of pocket.
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  Speaker 2: 70%.
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  Speaker 1: Medicare works much the same way with a colonoscopy. The
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  Speaker 1: screening is free until the doctor finds and removes a polyp.
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  Speaker 1: After that, the patient owes 15% of the cost, a
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  Speaker 1: share set to drop to 10% in 2027, and.
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  Speaker 2: Zero by 2030.
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  Speaker 1: Then there's a cost that never shows up on the bill, time.
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  Speaker 1: In one study, Ganglio and colleagues found that older adults
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  Speaker 1: in traditional Medicare spend an average of 5.3 days per
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  Speaker 1: year on lab tests. Number eight, the test results will
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  Speaker 1: follow you. Once a diagnosis lands in your chart, it
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  Speaker 1: stays there. The next doctor may read your chart before
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  Speaker 1: meeting you. An old or uncertain label can shape how
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  Speaker 1: the next doctor sees a new symptom and what gets
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  Speaker 1: tested for. Welch used to tell young doctors that removing
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  Speaker 1: an old diagnosis was as important as adding a new one.
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  Speaker 1: In practice, he said, doctors add far more readily than
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  Speaker 1: they ever subtract. And number nine, a normal test can
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  Speaker 1: often mislead you. A normal result often offers immediate relief.
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  Speaker 1: It only means to test it and find what they
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  Speaker 1: were looking for. It doesn't mean that nothing's wrong. Less
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  Speaker 1: than a week before Rich's father died, he had a
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  Speaker 1: physical and an EKG. A doctor told him that everything
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  Speaker 1: looked fine. The tracing didn't see the disease building in
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  Speaker 1: his arteries. Cat sees the same blind spot with coronary
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  Speaker 1: calcium heart scans. Calcium score of zero means that no
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  Speaker 1: detectable calcium was found in your coronary arteries. A younger
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  Speaker 1: person's score is zero, but still a soft plaque that
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  Speaker 1: hasn't hardened yet. Scan can't see it, and it can
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  Speaker 1: still cause a heart attack.
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  Speaker 2: Rich and his.
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  Speaker 1: Doctors agreed at the first scan because they figured there
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  Speaker 1: was nothing to lose. Turned out to be, at least
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  Speaker 1: for me, a big mistake, he said. A test is
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  Speaker 1: rarely a choice of nothing to lose. It can also
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  Speaker 1: be the right choice. The challenge for many patients is
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  Speaker 1: figuring out whether it's the right choice for them or
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  Speaker 1: how to prepare themselves for what the test might trigger.
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  Speaker 1: In a healthcare system geared to chase down symptoms and
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  Speaker 1: eliminate potential risks, a test.
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  Speaker 2: Can trigger a series of problems. New patients are not
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  Speaker 2: ready to face.
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  Speaker 1: The key is to know what will happen and weigh
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  Speaker 1: the risks and benefits before you say yes.
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  Speaker 2: A couple of questions can help. What will this test
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  Speaker 2: tell us that.
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  Speaker 1: We don't already know? What will we do differently with
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  Speaker 1: the answer? Will anything point toward a new test or
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  Speaker 1: away from it? A symptom is a beautiful teacher if
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  Speaker 1: we just simply listen.
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  Speaker 2: There you got it. Take it to heart. God bless,
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  Speaker 2: and I'll see you tomorrow.