The medical treadmill

That's what we call it around here. Go in with a simple complaint, or make an offhand comment during a routine exam, and the next thing you know you're a thousand or two or three in debt. That's not counting lost time from work, physical discomfort, and worry. And it's hard to get off the damned thing, because nobody wants to talk about when it's time to stop.

This is a phenomenon that Tara Parker Pope takes on here. Overtesting and overtreating is a huge problem, and it's one that's finally getting some attention. Granted, some of it is negative attention from the oh-my-god-death-panels crowd, but it's a serious question. Multiple screening tests have fallen under fire for the possibility that they cause more harm than good; intervals have been lengthened, the ages at which screening begins have gone up, or the test is no longer recommended as a routine screening. These recommendations are politically contentious, to say the least. 

I've had a couple of run-ins with overtesting in the last few years that have left me a skeptic. I found myself guilted into a mammogram at the age of 35 because my mother had breast cancer. After menopause. This means that there is no statistical increase in my risk, according to the doctor I saw. He wrote for it, though, and told me that it was the safest way to go. The nurse was horrified that I wasn't going to schedule it. So I went against my gut and did it anyway, because I can be a wimp like that. My insurance, of course, did not cover it and they shouldn't have. Completely unnecessary. 

I'm a lot less wimpy about that sort of thing now.

I've had two clear episodes of a neurological problem that looks an awful lot like MS. The thing is, there is no evidence of MS on MRI, or at least there wasn't the last time I had one, which was about a year ago. Efforts to diagnose the problem involved 3 specialists, 7 MRIs, and countless panic attacks. SEVEN MRIs, in less than 3 years.Multiple rounds of bloodwork, too, some of which again the insurance rightly refused to pay for, given that they were duplicates of labs that would not have changed I went along with this because I trusted my neurologist. But when I went up to see a neurologist at Tufts, he asked me why all of this had been done. And I didn't have a good answer for him. He gave me permission to stop seeing doctors, and apart from the 6 month follow-ups with my regular neurologist, I have. And at the last check? I turned down yet another MRI, since my symptoms haven't changed significantly since the last one.

The question of where to stop is a thorny one, but very, very important, and I'm glad that we're starting to look at it. The skepticism is overdue.