Doctors unveil "Choosing Wisely" campaign to cut unnecessary medical tests
Some doctors may be used to prescribing these seemingly "routine tests," but the "Choosing Wisely" initiative from the American Board of Internal Medicine Foundation says these procedures are often unnecessary and besides driving up the country's skyrocketing health care costs, can put patients at risk.
According to The New York Times, up to one-third of the $2 trillion of annual U.S. health care costs is spent on unnecessary hospitalizations and tests, ineffective new drugs and medical devices, unproven treatments, and unnecessary end of life care.
Nine leading medical specialty societies, including the American College of Cardiology and the American Society of Clinical Oncology , created lists of "Five Things Physicians and Patients Should Question." Along with ABIM, they're teaming up with the world's largest independent product-testing group, Consumer Reports, to spread the word that patients and doctors alike should stop and say "wait a second" at their next doctor visit.
"Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed," Dr. Christine K. Cassel, president and CEO of the ABIM Foundation, said in a written statement. "Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care."
The evidence is on the initiative's side. A 2010 Consumer Reports survey of 1,200 healthy adults showed that almost 50 percent of them had received screening tests for heart disease that were considered "very unlikely or unlikely to have benefits that outweigh the risks." A study in a September 2011 issue of the Archives of Internal Medicine found 80 percent of surveyed doctors said they order some tests that may not be necessary out of fear they might get sued for malpractice, HealthPop reported.
"I would say most doctors probably feel somewhat helpless when they're expected to practice defensive medicine and check off a whole bunch of boxes," Dr. Calvin Chou, a professor of medicine at the University of California, San Francisco, said at the time.
What tests should patients question? The American Gastroenterological Association says for colon cancer screening, low-risk patients (who don't have a family history) should not repeat screening for 10 years after a high-quality colonoscopy comes back negative. The American Academy of Allergy, Asthma & Immunology says physicians shouldn't order a CT-scan or "indiscriminately prescribe antibiotics" for sinus infections.
"We're not saying they should never be done, we're saying these are often unnecessary, and therefore the patients should ask the doctor, 'Gee, do I need this?'" Cassel told the Wall Street Journal.
The complete lists of all 45 things doctors and patients should question can be found here.
The initiative's backing by top medical societies may mean it's more likely to alter treatment standards, experts said.
"Overuse is one of the most serious crises in American medicine," Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the project, told the New York Times. "Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message."
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