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Physician groups just say no to unnecessary tests

Robin Wulffson MD's picture
unnecessary tests, patient harm, healthcare costs, patient advocate

Soaring healthcare costs are a major concern of the general public and health insurers; however, physician groups are also alarmed about the situation. These groups are well aware that many tests are unnecessary; thus, they are taking steps to curb healthcare costs. A 2005 National Academy of Sciences analysis reported that 30% of U.S. healthcare spending was unnecessary or wasteful; more recent studies have reinforced this statistic. That percentage of healthcare spending translates to $600 billion to $700 billion of annual unnecessary expenditures. These tests are not only unnecessary but can cause patient harm. For example, a CT scan exposes an individual to radiation and a heart catheterization carries a risk of hemorrhage or death.

On April 4, the American Board of Internal Medicine Foundation launched its “Choosing Wisely” campaign. It recommends that physicians perform 45 common tests and procedures less frequently; in addition, they are urging patients to question them if they are offered. Eight other specialty boards are preparing to join the campaign with additional lists of procedures that they deem physicians should perform far less often. Although similar campaigns have been launched in the past, the new one has the added clout of physician backing; thus, it may have a major impact on treatment standards in both hospitals and physicians’ offices nationwide. The nine physician groups comprise approximately 375,000 members.

The physician groups are joining forces with AARP, Consumer Reports, and 10 other consumer groups to fuel the campaign. The physician groups are: American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; American College of Cardiology; American College of Physicians; American College of Radiology; American Gastroenterological Association; American Society of Clinical Oncology; American Society of Nephrology; and American Society of Nuclear Cardiology.

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A partial list of procedures that should be questioned:

  • Antibiotics for sinus infections: Many sinus infections are caused by viruses. Antibiotics are not effective against viruses; they only work against specific bacteria. Unnecessary antibiotics increase the risk of developing resistant strains.
  • CT or MRI scans of the brain for fainting: These tests are not indicated unless signs of a seizure are also present.
  • CT scans for appendicitis in children: A less expensive ultrasound scans is preferable.
  • Stress tests for healthy individuals: Heart screening tests are not indicate unless the patient has a risk factor such as diabetes or hypertension.
  • PET, CT, or bone scans to check for the spread of early prostate or breast cancers: If tumors are low grade (i.e., at low risk for metastasizing) the scans can lead to unnecessary surgery, radiation, or chemotherapy.
  • Repeat colonoscopies within 10 years: For individuals with a low to average risk for colon cancer, once a decade is enough.
  • X-rays for low back pain: Unnecessary unless certain symptoms or findings are present that can indicate the possibility of serious disease (i.e., weakness in the legs from pressure on a nerve).

The entire list of 45 (often) unnecessary tests and procedures is online at choosingwisely.org.

Take home message:
It would be prudent for all individuals to review the list of unnecessary tests as well as future updates. Your consent is required for any medical procedure to be performed. For children or individuals in a compromised mental state, the consent of a parent or guardian is needed unless a critical situation is present (i.e., a patient brought to the ER comatose and hemorrhaging from an automobile accident). You or your advocate can question any procedure and/or seek a second opinion. If possible, everyone should develop a relationship with a physician whose opinions they trust.

Reference: “Choosing Wisely” campaign