How Does One Decide to Stop Getting Medical Tests?

I am astonished at the number of diagnostic tests prescribed for older seniors. When my husband’s mother was 90, she had a gynecological exam — we suggested it and the doctor carried it out — and though I knew the doctor was gentle, Mother cried out because of the discomfort. Afterward we wondered why we put her through this exam and what we might have done if the test had identified the problem. We worried that we might have caused more health problems, especially the urinary tract infections were an ongoing problem, given Mother’s frail health. Ditto a year earlier when she prepped for a colonoscopy.

Every time my parents go to for a diagnostic test, I worry about what germs and complications they might bring home.

I don’t know the answer to this question, but several recent articles have reminded me how many of these diagnostic tests are performed and re-performed on elderly patients, despite that in the last years of life greater risks arise from the tests than from many of the health conditions.

The following three articles explore these issues.

Concern is Growing that the Elderly Get too Many Medical Tests, a Kaiser Health News article, describes how many diagnostic tests for slow-moving chronic conditions and diseases can cause anxiety, frustration, and discomfort. In this September 12, 2011 article, author Sandra Boodman shares information about recommendations from the U.S. Preventive Services Task Force (guidelines for older adults), a group that examines and evaluates the potential problems with medical tests.

In her September 29, 2011 Well blog article, Why Doctors Order So Many Tests, Pauline W. Chen, M.D. writes about the quandary of many doctors who continually ponder whether they should order tests or prescribe medications just because their patients are expecting these services.

In her October 15, 2011 New York Times opinion piece, How Medicare Fails the Elderly, Jane Gross, who recently published a book about her elderly mother’s health struggles in the last years of life, describes a convoluted Medicare payment system that pays for advanced diagnostic tests, surgeries, and medical care that often result in poor outcomes, while at the same time not paying for simple care and support that would increase the quality of life and keep people out of hospitals in the first place.