Wednesday, November 10, 2010

Surprising common sense from website Cracked.com: “5 common medical procedures that secretly aren’t worth it”

Yesterday, the humor website Cracked.com published a list of 5 common medical procedures that, in its opinion, aren’t worth it. They are CT scans, physical examinations, circumcisions, Cesarean sections and antibiotics. OK, antibiotics are not really procedures, but you get the point. Of course, the author uses exaggeration to bolster his case but there is a lot of truth in the article. Let’s take them one by one.

5. CT scans. No doubt about it, they are overused and they are expensive. And there is a theoretical and possibly real risk, albeit small, of an increase in cancer rates in the future. Cracked thinks the increase in the use of CT scans is about money and greed but the fact is that doctors who order CT scans almost always do not own the scanner and do not profit from ordering the test. I think it’s about the public’s demand for diagnostic accuracy (I blogged about this in August) and the pervasive practice of defensive medicine. Physicians feel compelled to cover their asses by over-ordering confirmatory tests before doing anything and they fear being sued for missing something. As an alternative, Cracked.com suggests increasing the use of MRI. Although MRI does not involve radiation to the patient, it is also very expensive and not routinely available on a 24/7 basis. For some illnesses, it is just not as good as a CT scan for diagnosis.

4. Physical examinations. I could not agree more that they are useless in asymptomatic patients.

3. Circumcisions. More than 35 years ago, circumcision was shown to be not only unnecessary, but probably harmful in that occasionally a child was mutilated by technical errors with the procedure. Children with unsuspected hereditary bleeding disorders have even died during circumcision. Why the practice continues is inexplicable. I tweeted about this a few months ago and am proud to be now listed by the tweeter “Intact by Default” as disfavoring circumcision.

2. Cesarean sections. There are certainly too many Cesarean sections done in the U.S. Some are performed for the convenience of the patient or the obstetrician. However, the procedure can be “worth it” in selected patients. Examples of necessary Cesarean sections are the baby is too big to be delivered vaginally, the mother has a major complication of pregnancy or labor, some multiple births and others. Cesarean sections may also fall into the defensive medicine category as one can always question why a baby with a subsequent problem was delivered vaginally instead of by Cesarean section.

1. Antibiotics. Please, don’t get me started. Again although not a procedure, Cracked.com is spot on that antibiotics are vastly overused in medicine (and agriculture, by the way). In most hospitals, anyone who develops a fever gets antibiotics. Everyone wants antibiotics for a cold despite the fact that colds are caused by viruses (not affected by antibiotics) and colds are self-limited, non-fatal diseases. Overuse of antibiotics leads to bacterial resistance, which is now a major problem worldwide. They also cause diarrhea and a sometimes lethal infection called C. difficle colitis, which often attacks hospitalized, debilitated patients.

So let’s give Cracked.com an A- for its list. Too bad more physicians don’t read it. And too bad we live in a litigious society which fosters defensive medicine.

2 comments:

Anonymous said...

1. I'm surprised you read Cracked.
2. They have ton of good lists on there.
3. Did another Doc write that list? Usually the lists aren't so substantial.

Skeptical Scalpel said...

Confession: My daughter sent the url to me. I will follow it from now on. The Cracked article states that it was written by doctors. I believe it.

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