Urologists may over-use diagnostic tests at times, but for good reason

May 01, 2010

Overall, most of the urologists who were interviewed considered the CT scan the gold standard for approaching many diagnoses.

Most of the physicians who spoke to Urology Times don't think tests are over- prescribed, but they do see reasons for over-testing, including defensive medicine. Interestingly, some academicians think over-testing could more easily occur in private practice, where there is an economic incentive to perform tests on privately owned equipment, while some private practitioners think tests might be done more readily in an academic setting when patients come in for second opinions.

Overall, most of the urologists who were interviewed considered the CT scan the gold standard for approaching many diagnoses.

"In emergency room settings, I could see the potential for tests to be overused, because the physician probably does not know the patient and will order a CT scan when there are complaints of abdominal pain," Dr. Elfarr said. "In my personal practice, that wouldn't happen. Basically, I order a CT when it's indicated for the patient. That includes other imaging studies as well.

"The CT scan is probably one of the most common things we order. If the patient has gross hematuria or if there's a questionable stone we are following, the CT scan is now the standard of care. So in that respect, they are not over-ordered," he said.

Private practice vs. academics

"In an academic practice, because so many patients are referrals for second opinions, doctors may end up doing a lot of PET scans and MRIs. The patients may have already had a CT scan from their primary care physician or urologist," Dr. Waxman said.

"But when there is a question about a renal lesion and the consulting physician is asked what they think, the person trying to deliver a second opinion sometimes wants to get another study. Most urologists don't seem to do PET scans; urologic oncologists may be more likely to order that. I think most urologists are more comfortable with CTs and MRIs and not as comfortable with PET scans.

"MRIs have a good place if you're looking at a lesion that is questionable on CTs. Then, MRIs sometimes enhance the value, but I don't think they're overused," he added. "I don't think anybody jumps right into MRIs because most urologists are more familiar with CT scans and they'll do that before they go to an MRI."