Friday, April 6, 2012

Doc Groups Identify Unnecessary Tests

When nine prestigious Medical Specialty Groups get together and identify tests that are unnecessary and wasteful, it is time to take notice.  In a rare effort, each specialty identified 5 tests and procedures that do not add value and that may be unnecessary or overused.  In all, 45 tests and procedures were listed as part of the ABIM "Choosing Wisely" campaign, a multiyear initiative that aims to reduce the waste in medicine and increase dialog between patients and physicians. 

What are some of the 45 tests and procedures we should not do?

From The Academy of Allergy, Asthma and Immunology:
  • IgG and a battery of IgE  and other unproven allergy skin tests.
  • Antibiotics for uncomplicated sinusitis (only .5-2% are bacterial infections)
  • Inhalant or food testing or extensive diagnostic tests for chronic itching/hives.
From the American Academy of Family Physicians:
  • Xrays or MRI scans for low back pain within the first 6 weeks. (unless exam points to red flags).
  • Dexa bone scans in women younger than 65 or men younger than 70 with no risk factors.
  • Routine EKGs in patients without symptoms.
  • Pap smears on women younger than 21 or women who have had a hysterectomy for non-cancer disease.
From The American College of Cardiology:
  • Annual cardiac stress tests as part of routine follow-up in patients without symptoms.
  • Stent placement in the non-infarct artery of patients who are stable, even if they have a ST-segment elevation myocardial infarction (STEMI) in another artery.
From The American College of Physicians:
  • Pre-op screening chest X-rays.
  • CT or MRI scans for a simple fainting spell if patient has no neurological findings on exam.
From The American College of Radiology:
  • Imaging for uncomplicated headache.
  • Routine admission Chest Xray.
  • Follow up imaging for small (under 1cm) ovarian cysts  (common and usually benign). 
From The American College of Gastroenterology:
  • Colorectal cancer screening before 10 years after normal colonoscopy.
From The American Society of Clinical Oncology:
  • PET, CT and bone scans for early prostate cancer at low risk of metastasis.
  • PET, CT and bone scans for asymptomatic patients that have been treated for breast cancer for curative intent.
These are just a few of the noted "wasteful" tests that do not provide value to patients.  Any and all of these are valuable  IF a patient has symptoms that require diagnostic testing but using them as "screening" or routine tests has no value and can actually cause harm.  Not to mention $billions of wasted health care dollars.

Some doctors do these because of habit, prior training, not keeping up with current literature,  fear of litigation or patient pressure to "do everything".  When esteemed specialty societies come out with lists like this, we should all take notice.

   Of course it is up to the individual patient and the individual physician to determine risk factors and risk/benefit of any test.  But these lists should at least stimulate the question "why" and valid reasons are necessary.

1 comment:

Michael Kirsch, M.D. said...

I'm delighted to be the first to comment on this fine post. This is the strategy that has to gain a foothold in medical care and then burn like a brushfire across the profession. In my view, if the waste in the system could be culled, the system would be reformed and we'd be rolling in extra cash.

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