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Medical groups recommend ending routine use of 45 tests and procedures

MRI scanner
REUTERS/Jean-Paul Pelissier
New guidelines suggest when certain medical tests may not be necessary.

On Wednesday, nine leading medical specialty groups released lists of 45 different common tests and procedures (five for each specialty) that doctors should stop offering routinely to patients.

What’s remarkable about this action is that many members of the medical profession have vigorously defended the use of these tests and procedures in the past, even in the face of growing evidence that they may not only be unnecessary, but harmful.

As the New York Times reported, the new lists are likely to “alter treatment standards in hospitals and doctors’ offices nationwide.”

The lists are part of a project dubbed “Choosing Wisely.” It’s an initiative launched by the American Board of Internal Medicine Foundation in conjunction with Consumer Union's Consumer Reports.

"We're not saying they should never be done, we're saying these are often unnecessary and therefore the patient should ask the doctor, 'Gee, do I need this?" Dr. Christine Cassel, CEO of the foundation, told Wall Street Journal reporter Anna Mathews.

As a commentary in the Journal of the American Medical Association points out, physicians must lead the way with eliminating unnecessary treatments because their decisions account for about 80 percent of health-care expenditures.

"Yet," write the authors of the commentary, "physicians do not always have the most current effectiveness data, and despite acting in good faith, they can recommend diagnostic or therapeutic interventions that are no longer considered essential. Also, research shows that physicians may need help communicating these matters to their patients. This may be especially difficult when clinicians and consumers are deluged with advertising and promotion. Clinicians often report feeling compelled to accommodate patients' requests for interventions they know are unnecessary. At the same time, patients need trustworthy information to help them better understand that more care is not always better care, and in some cases can actually cause more harm than good."

Here is a sampling of the groups’ recommendations (some of their recommendations overlap):

  • Do not do imaging for low back pain within the first six weeks, unless red flags are present. (American Academy of Family Physicians and American College of Physicians)
  • Do not routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for seven or more days or symptoms worsen after initial clinical improvement. (American Academy of Family Physicians and the American Academy of Allergy, Asthma, and Immunology)
  • Do not give cardiac imaging tests (particularly stress tests or advanced noninvasive imaging) if there are no symptoms of heart disease or if high-risk factors such as diabetes or peripheral arterial disease are not present. (American College of Cardiology)
  • Don’t do CT scans or MRIs on patients who have fainted when there is no evidence of seizure or other neurologic symptoms.  (American College of Physicians)
  • Don’t do routine X-rays on patients entering the hospital for surgery unless there is an indication of heart or lung disease. (American College of Radiology)
  • Don’t do imaging for uncomplicated headache. (American College of Radiology)
  • Don’t repeat colonoscopies within 10 years after a test with negative results and when the patient has an average risk profile for colorectal cancer. (American Gastroenterological Association)
  • Don’t screen women under 65 or men under 70 for osteoporosis, unless they have a high-risk profile for the condition. (American Academy of Family Physicians)

Other groups that participated in this stage of the Choosing Wisely initiative were the American Society of Clinical Oncology, the American Society of Nephrology, and the American Society of Nuclear Cardiology.  Eight other medical specialty groups are also working on lists, which will be released at a later date.

You can download all nine lists of recommendations — along with the explanations of why the different tests and procedures made the list — at the Choosing Wisely website.

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Comments (4)

It's no coincidence

that health care costs started skyrocketing when both pharmaceuticals and trial lawyers were allowed to start advertising their products and services on the TV.

Reduction in testing will be better received by doctors when its accompanied by tort reform to reduce the prohibitive costs of malpractice insurance that drive much of the "unnecessary" testing.

Poppycock

Your so called "facts" are pure rubbish. Costs started escalating with consolidation of payers and rising rate of uninsured. That creates cost shifting. And AMA figures show the recent raises in costs were more than 50% rise in physician costs-fee increases. Now this was partly due to rates being held down the previous couple of years, but it was simply not, in any way, related to ads by anyone. Those ads are a pain in the rear as we spend time explaining why the new pill is expensive and insurance will not pay for it. Malpractice/defensive testing is less than 1% of medical costs. Tort reform should occur for other reasons, but it ain't direct costs.

The next question

So then the next question is, what are the standards for "red flags" and "a high-risk profile"? For osteoporosis, for instance, does it include a mother who's broken her hip from a fall, or what?

Some members of Congress

and maybe in our legislature (not sure) have tried for years to make direct-to-patient advertising illegal, but it would seem that Big Pharma has more power than they.

Pharma's research show that advertising including those ever-present words, "Ask your doctor if ............ might be right for you," actually does lead people to show up at their doctors' offices to ask that very question. Sales for the advertised product always increase while those for generics are harmed by the ads.