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.”
“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.