MAKE THEM PAY FOR THE TESTS AND THEY'LL STOP GETTING THEM:

GETTING THE MOST OUT OF MIDLIFE: How much medical testing is too much? (Amanda Leigh Mascarelli, April 30, 2011, LA Times)

Experts acknowledge that the fear of being sued can sometimes influence a doctor's decision to order more tests. A patient may come in complaining of chest pain, and the doctor may be fairly certain it's not heart-related. But then she may think, " 'Well, there's a 0.1% chance that it is, and what if I didn't do the stress test?'" says Dr. Christopher Cannon, a cardiologist at Brigham and Women's Hospital in Boston.

But in other cases, such as with cholesterol checks, pressure from patients can prompt doctors to order tests they might otherwise skip, Cannon says. In many cases, "the tension is more the demand of the patient, of 'I want to know, do I or don't I' " have a certain condition, he says.

Yet another reason for excessive screening: It's easy.

Consider the PSA test to screen for prostate cancer. Once considered routine, the American Cancer Society no longer makes a blanket recommendation that men get the test; the U.S. Preventive Services Task Force says there's no good evidence either for or against the test for men younger than 75, and it advises men 75 and older to skip it. But patients may not realize this.

"It would take a lot longer for the doctor to go over the data for why screening with a PSA in his age group is not a very effective approach for picking up prostate cancer because there's going to be many more false positives than true positives," Braunstein says. "That's a 15-minute discussion, whereas it's one minute to write the order for a PSA. And if you don't write the order for a PSA and that's what the patient wants, then you've got an unhappy patient."

Dr. Nortin Hadler, a rheumatologist at the University of North Carolina and author of "Worried Sick: A Prescription for Health in an Overtreated America," estimates that only about 20% of our health and life expectancy is based on measurable risk factors for disease. The other 80% can be boiled down to quality of life, which Hadler sums up with two questions: "Are you happy in your socioeconomic status?" and "Do you like your job?"

"It's very powerful," he says.

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