Medical Procedures that go wrong

. Pondering all the random, horrible ways we can get sick is enough to scare anyone stiff.
Hence the proliferation of new health screens--many not covered by insurance--that try to detect disaster early so patients can put up a decent fight. Screens differ from diagnostic tests in that screens are aimed at patients who are not at unusually high risk and exhibit no particularly alarming symptoms.

The problem: Plenty of screens don't really work that well. Many yield lots of false-positive results, which lead to unnecessary (and risky) treatments. Other tests work, though not in time for patients to act, leaving them to a life of endless dread.
"People forget that there are two sides to screening," says Dr. Barbara Yawn, director of research at Olmstead Medical Center and a member of the United States Preventive Services Task Force, a government-backed group of health care professionals that study and evaluate health screens. "[Screens] can be beneficial, but there are always other risks."

In Pictures: Seven Health Screens To Think Twice About
Here's one horror story, from Dr. Robert Centor, dean of the Hunstville campus at the University of Alabama School of Medicine. Several years ago, during a simple diagnostic chest X-ray, Centor discovered a growth on the lung of one of his patients, who appeared to be in good health. He performed a biopsy to remove the nodule, which turned out to be benign. The patient, however, caught an infection at the hospital and died a few days later.

Despite the risks, health screens are on the rise. While no hard data exist, Yawn says the Preventive Task Force has been asked to review significantly more screenings in the past four years. Dr. David E. Bruns, director of clinical chemistry at the University of Virginia and editor of Clinical Chemistry, says he has seen an increase in the number of tests cited in his medical journal.
Health screening is a business run on fear. "If you find an issue of huge concern to the public and you can market peace of mind, particularly [with regard to] cancer or heart disease, people are willing to buy it," says Dr. George Isham, chief health officer of HealthPartners, a health maintenance organization in Bloomington, Minn. "So you see a lot of tests pop up before there's good hard evidence of whether they work or not."

Indeed, the findings by the Preventive Services Task Force are underwhelming at best: Of the 60 health screens the group has evaluated, it advises that physicians use only 29--and 10 of those, it says, should be done only at the physician's discretion.

Recommended tests are those that the Task Force believes deliver sufficient preventive value--net of false readings and the risks association with doing further procedures based on them. Some commonly recommended tests include Pap smears (to screen for cervical cancer in sexually active women), high blood-pressure tests, colorectal cancer screens and something called the Factor V Leiden test, which checks a person's predisposition to blood clots.

If a certain disease runs in the family, testing may be a no-brainer. In many other cases, the decision is anything but clear.
"Every advocacy group out there has a slightly different set of recommendations on screenings, so people get confused," says Isham. "Doctors and patients are getting conflicting messages about which tests to use."

Even recommended tests yield a scary number of false readings. Take mammograms, an often promoted and routine exam. According to research compiled by the U.S. Agency for Healthcare Research and Quality, the percentage of false-positive readings is between 7% and 8% for women aged 40 to 59 who took the test. That figure drops to around 4% for women 60 to 79, mainly because the chances of getting breast cancer rise the older women get. If every woman between 40 and 59 in the U.S. had a mammogram, a few million would be fretting unnecessarily over a wrong result.

When it comes to health screens, says Yawn, "it's really important to be honest with patients--what a test is likely to cost in terms of pain, angst and visits to the doctor."
The other problem: Many screens don't discover diseases in time to treat them. "It sounds great to catch cancer early, but it doesn't help unless you can treat it,” says Centor. “You need to be able to change life expectancy and possibly quality of life because of the diagnosis."
Which screens should you think twice about before having?
Perhaps the most dubious are "total body scans." These screens, performed using electron beam computerized tomography, are advertised as a tool that ferrets out cancers, heart disease, aneurysms, you name it. Many radiologists have set up freestanding businesses to peddle these scans.

In reality, the scans are more likely to pick up "incidentalomas"--blips that don't necessarily mean anything but require a follow-up test, says Dr. Roseanne Leipzig, professor of clinical and geriatric medicine at Mount Sinai School of Medicine.
According to recent research by G. Scott Gazelle, director of Massachusetts General Hospital's Institute for Technology Assessment, 90.8% of patients who had a full-body scan got a least one positive finding that led to additional testing. However, only 2% of those actually had a disease. Worse, these tests cost between several hundred and several thousand bucks--and most insurance companies won't pick up the tab.
Prostate-cancer screens create their own dilemmas too. These involve a blood test that looks for unusually high levels of prostate-specific antigens (PSAs). The American Cancer Society suggests men in their 50s take this test yearly (along with a digital rectal exam), but there are two potential flaws.

First, PSA levels generally increase with age and can be inflated because of more benign problems in the prostate, leading to false-positive results. Many men end up having unnecessary biopsies. Second, prostate cancer tends to grow very slowly, which means it might not kill you--or if it does, it will happen much later in life.
The calculation for patients: Skip the test and take your chances, or cut out the cancer early and risk post-surgery downsides like incontinence, impotence and a lot of discomfort.
Then there's the battery of computerized tomography scans. Since 2004, the National Cancer Institute has been conducting trials to see if CT scans (and standard chest X-rays) can reduce mortality in smokers by detecting lung cancer early. Sadly, there's little evidence thus far that supports this technique. In most cases, even with a CT scan, the cancer is found too late.
A full evaluation of the efficacy of CT scans will take at least several more years before any results are found. "These trials require such a large number of people because of the rareness of lung cancer in the overall population," says Isham. "It'll be some years before we have a conclusive answer on that. Good science takes a long time."

On a recent Thursday at 6 a.m., Daniel Gonzalez, head of Hogan and Hartson's international arbitration and litigation practice, landed at Reagan International Airport in Washington, D.C., capping off a three-day business trip to Argentina. Up next: an early afternoon meeting with the Securities and Exchange Commission. Between his major commitments, he juggled bits of 15 other cases. Talk about pressure.

How do Gonzalez and other stressed-out high-performers like him keep from cracking?
For many, relieving stress is about maintaining control--or at least some semblance of it. When Gonzalez travels--between 30 and 40 weeks a year, bouncing between Latin America, Europe, Asia and United States--he uses both a laptop and Blackberry to impose a little order. "I know I can be responsive no matter where in the world I am at any given time," he says.

In Pictures: Ten Star Athletes On Staying Cool Under Pressure
Indeed, most scientific research shows job-related stress is most severe when people have high demands and little control, or perceived control, over the forces at play. A production-line worker may have a very defined, repetitive, 9-hour job but still be swamped with stress because the fate of his job is far beyond his control. The greater your feeling of control, the lower your overall work-related stress level will be, says Peter Schnall, director of the Center for Social Epidemiology at the University of California, Irvine.

Eventually, though, the long hours will get to you. Based on data from a 2001 California Health Interview Survey, Schall's research indicated people who worked 51 or more hours per week were 29% more likely to develop hypertension, versus 14% of workers that put in 40 hours a week. Such stress can also lead to heart disease and depression.
The cost of all work-related stress is squishy, but no doubt high. The American Institute of Stress estimates stress costs U.S. corporations $300 billion annually in health care costs, turnover and absenteeism. A survey by the same institute also reports more than one in four workers say they take a "mental-health day" at least once a year, specifically because of work-related stress.

The first step to wrestling with job stress is to nail down what specifically is stressing you out. "People tend to experience stress in a generalized way," says Russ Newman, executive director of the American Psychological Association. "There are going to be particular causes and triggers, but unless you take the time to look at them, you're not aware of what you're dealing with."
Sometimes those triggers are hard to pinpoint. One trick: When stress hits, put down the circumstances on paper, says Dr. Paul Rosch, president of the American Institute of Stress. That way, you can go back to your notes in a calmer moment and nail down on the source of your stress.


Once you figure out what's eating you, take some quick, smart steps to unwind, says Newman. And by that he means exercising or taking incremental breaks, not chain-smoking or binge drinking.
Next, divide the stress triggers into two categories: those you can control and those you generally can't. Obviously, knock out the ones you can control first.
As for the ones you can't, try to mollify their effects. Some things that seem out of your control may not be. It's helpful to work through these issues with an outsider, like your spouse or a friend, to gain perspective, says Rosch. If the source of your stress is truly immutable, think about changing how you experience it.
Take commuting: If driving to work for hours each day causes stress, and it's impossible to move or work from home, Rosch suggests buying a set of books on tape. Changing the experience--and thereby giving yourself more control over the situation--can lower your stress.

Another way to beat stress: Root out inefficiencies. Matt Grawitch, a professor at St. Louis University who studies work stress, saw this first-hand on a recent consulting assignment at a local hospital. In one wing, the nurses printed patient charts from one of two stations at opposite ends of the hallway. For some reason, when nurses printed charts, it was impossible to specify which printer to use, and thus where the charts would emerge. "The nurses were wasting hours a day walking to the wrong printer and walking back to the right one," he says. Result: A boatload of unnecessary stress.
Planning can also nip stress in the bud. Gonzalez says he carefully prioritizes his tasks, deciding what is possible to get done in a given week and what isn't. In any system operating near capacity, hiccups create greater problems than those with at least a modicum of slack. "Planning allows me the variable of the unknown, and to accomplish things under the highest-stress situations when emergencies come up," says Gonzalez.

And when in doubt, try a little humor, says Lloyd Greif, the founder of the Los Angeles-based mergers and acquisition firm Greif & Co. (His firm's motto: T.I.G, or "Trust in Greif.") "As an investment banker, you surround yourself with 'type As'," he says. "When things get the most stressful in the boardroom, I'm always going to say something off-the-wall to break the tension. Otherwise, the mood is going to be such that it's tough to get things done." 'Off-the-wall' comments include addressing one of his clients as 'Mutley,'
because, Greif says, the guy laughed like the old Hannah-Barbera cartoon dog.
Dr. Rosch says different people experience stress very differently. He compares stress levels to people's experiences on a rollercoaster. Some people panic, while others love the thrill. And still others are adept at using one to diffuse the other.
Top athletes do this well. Jermaine O'Neal, forward for the Indiana Pacers basketball team and six-time NBA All-Star, puts it this way: "Pressure in sports is nothing. That's the job. When the stage is bigger--the playoffs, for example--that just makes it more exciting. It's like being a kid the night before Christmas. Okay, maybe you do get a little tighter shooting a free throw at the end of a game on the road, with fans going crazy behind the backboard. But you know you've practiced that shot to win. So when you get that opportunity, that's just fun."

One last word on stress: If you're going to vent, do it with caution. Venting should be cathartic--not a way to keep reliving the same stress. "If you go down the hall to vent to an associate, that's okay," says St. Louis University's Grawitch. "But if the next step is to go upstairs and vent to someone else, then you're holding onto the incident, and it can become very disruptive."