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Life Line Screening

Posted Dec 29 2009 5:15am
They advertised in our small town with great fanfare and swooped in setting up shop at the local motel. For about $200 they'd run their battery of tests and give you a clean bill of health or refer you back to your doctor to follow up with this valuable information.

And so went a vigorous 82 year old male who I've told on several occasions is the model of health. Afterward he came into the office with a stack of papers anxious and uncertain of what it all meant, but he could tell from the green, yellow, and red color coding scheme not everything was green.

I knew he was going to want me to interpret every test Life Line had done so we just started up at the top and worked our way down.

1. Carotid arteries: Mild stenosis bilaterally. Not normal (and therefore was color coded yellow), but at 82 pretty darn good. Flipping through the patient's chart this also matched up the carotid dopplers done less than two years earlier when he was having some dizzy spells. I guess he really didn't need that one.

2. 6 lead EKG: No signs of atrial fibrillation. He was happy this was in the green zone. Once again this confirmed my last EKG from less than two years ago as well as several physical exams exam the past year which has always failed to show that characteristic irregularly irregular rhythm. Probably could have done without this one too.

3. Ankle-Brachial Index (ABI): This comparison of blood pressures in the arm to feet looks for signs of peripheral vascular disease. Sure, he wasn't having any symptoms such as claudication, he has never showed any evidence of atherosclerotic disease anywhere, and medical evidence says the ABI is a reliable test, but picking up asymptomatic cases offers no benefit to waiting until patients are symptomatic, but what the heck? An ABI is an easy and inexpensive test to do. Not surprising his result was normal.

4. Abdominal Aorta Screen: The US Preventive Services Task Force (which has taken so much heat as of late, unfairly in my opinion) came out with a recommendation a few years ago that men over the age 65 with a history of smoking should have their abdominal aorta scanned once to screen for an aneurysm and if present should obviously be followed. This 82 year old gentleman smoked one cigarette in his life, became violently ill and never smoked again. His aorta was normal. I guess the guidelines were right on that one. Probably didn't need the test.

5. Bone Density Testing: Given the morbidity and mortality of vertebral compression fractures and hip fractures I tend to order a lot of these tests for my patients. However, medical evidence recommends the test for women 65 and over, or perhaps sooner if significant risk factors may be present. For men there has never been shown to be any benefit to bone density testing unless risk factors such as frequent steroid usage are present. Looking at this sturdy man with perfect posture who I know exercises vigorously and has never required a course of prednisone in his life I could have told him his test would be normal. It was.

6. Lipid Panel: Reasonable test to do as more evidence emerges on the benefits of lipid management in elders. In fact I had ordered one for him just over a year before and the results were basically unchanged and pretty good at that. No change in management done.

7. Blood glucose: Another very reasonable screening test supported by good evidence. This patient's blood sugar placed him in the glucose intolerant range, or pre-diabetes. This was actually somewhat higher than the fasting blood sugar I'd checked in the office just over a year ago when I also had checked his cholesterol. We discussed what this meant and agreed as long as he kept mowing his acreage with his push mower and continued his healthy eating habits, this would be very unlikely to play a significant role in his life.

So was this information worth the $200 he paid for the testing? Were any of these tests unnecessary for this individual patient? The broader question is when are we going to stop blindly believing that all testing is good and if it is expensive and high tech then it must be really good?

The Country Doctor
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