Nine Doctor Groups Speak Out Against Costly, Useless, and Potentially Harmful Medical Tests and Treatments

For the cynics among you, her's a bit of good news from the medical world. In conjunction with Consumer Reports, nine medical specialty groups have each identified 5 tests and treatments that are frequently overused, as part of a project organized by the American Board of Internal Medicine (ABIM). Further data is pending from eight more groups.

Here is an excerpt from Medscape that describes the effort:

"Called "Choose Wisely," the project is aimed at encouraging patients as well as physicians to follow evidence-based guidelines in managing health problems, avoiding medical procedures that are unlikely to be of real help.

Each of the nine societies compiled a list of "Five Things Physicians and Patients Should Question," focusing on tests, drug therapies, and procedures that they viewed as often ordered without consideration of risks and costs relative to the benefits.

Each of the nine societies compiled a list of "Five Things Physicians and Patients Should Question," focusing on tests, drug therapies, and procedures that they viewed as often ordered without consideration of risks and costs relative to the benefits.
In a Viewpoint article published online in the Journal of the American Medical Association, two officials of the ABIM and Consumer Reports said the effort is aimed at reducing waste and needless harm in the healthcare system.

"The hope is that the lists will spark discussion between clinicians and patients about the need -- or lack thereof -- for many frequently ordered tests or treatments," wrote ABIM President Christine Cassel, MD, and James Guest, JD, president of Consumer Reports.

The nine societies joining the first prong of the project are the American College of Radiology (ACR), the American College of Physicians (ACP), the American Academy of Allergy, Asthma, and Immunology (AAAAI), the American Academy of Family Physicians, the American College of Cardiology, the American Gastroenterological Association (AGA), the American Society of Clinical Oncology (ASCO), the American Society of Nephrology (ASN), and the American Society of Nuclear Cardiology (ASNC)."

Here are my top 12 (out of 45) that I think are noteworthy

1. Routine antibiotics and CAT Scans for treatment and diagnosis of sinus infections as recent study demonstrated that 90% of infections are caused by viruses that do not respond to antibiotics.
2. Routine diagnostic testing for chronic hives as causes are almost never discovered and testing does not improve outcomes.
3. MRIs and CT Scans for back problems of less than 6 weeks duration unless there are neurological problems that indicate potential severity.
4. Pap smears in women younger than 21
5. Heart disease screenings, such as EKGs, echocardiograms, stress tests, and carotid ultrasounds for people at low risk of heart disease.
6. Brain MRIs or CTs after a simple fainting episode.
7. Routine chest x-rays before surgery unless there is known disease.
8. Imaging tests for headaches in the absence of specific risk factors
9. Use of long term acid suppressors [like prilosec] for heartburn. Minimum does should be used to control symptoms.
10. Wait 10 years to repeat negative colonoscopy and wait five years after colonoscopy with minor findings.
11. Avoid PET, CT, and radionuclide bone scans diagnostic screening for early stage prostate and breast cancer.
12. Minimize the use of radiation-based cardiac-imaging whenever possible given the risks of radiation versus benefit of results analysis.

It is wonderful that these medical groups have taken the lead to cut down on tests that not only don't provide benefits but pose harms such as in the form of unnecessary radiation exposure. Many of these tests and treatments are part of the routine landscape of medical practice and we can hope that Consumer Reports will do a great job of publicizing these recommendations so doctors and patients alike can avoid costly, non-beneficial services. Isn't it a wonderful day?