Re: Prostate-Specific Antigen Testing among the Elderly in Community-Based Family Medicine Practices

To the Editor: I read with interest the original research article, “Prostate-Specific Antigen Testing among the Elderly in Community-Based Family Medicine Practices,” by Hudson et al.¹ Doctor-directed clinical activities that are unsupported by medical evidence and ignore credible guidelines can be summed up in 2 words: thoughtless practice. Some of the harms that follow thoughtless screening practices include:

• Lost opportunities: doctor-patient interactions that stray into inappropriate screening risk missing opportunities to focus on more useful testing or to bypass screening in favor of directly providing effective preventive services.

• High rate of false-positive results: screening tests reveal incidental “abnormal” results that lead to patient anxiety, false diagnostic labeling, and more testing that compounds risk and increases costs.

• Impracticality: the discovery of disease that cannot be modified or disease in the presence of treatment-limiting comorbidities is unlikely to alter the extent or quality of a patient's life, and because of treatment side effects and risks, may decrease both.

• Diversion of resources: no matter how distant the consequences of inappropriate testing may seem, health care spending is bound by the rules of all zero sum enterprises—dedicating resources to wayward testing subtracts from our ability to deliver beneficial services.

• Decreased trust: when doctors recommend medical services that are not clinically indicated, informed patients become less confident in the knowledge and integrity of individual doctors and the medical profession in general.

As lawmakers and the public seek advice on how to effectively provide health care in the face of increasing needs and diminishing resources, can Family Medicine doctors genuinely expect to be listened to if we cannot overcome our patients’ and our own fondness for expensive futility?