Unnecessary medicine: Physician groups list 45 overused tests, procedures
Nine organizations release lists of medical exams and treatment that are often unneeded, costly — even possibly harmful
CT scans for cases of acute rhinosinusitis are unnecessary because most cases can be diagnosed clinically and resolve without treatment in two weeks, says the American Academy of Allergy, Asthma & Immunology. (Francesco Ruggeri, Getty Images / April 3, 2012)
In most cases, no.
But patients get these commonly used tests and procedures — and many more — all the time, even though medical experts say they often are unnecessary, can be harmful and contribute to the nation's skyrocketing health care costs.
On Wednesday, nine physician specialty societies collectively representing about 375,000 physicians nationwide are each unveiling a top five list of tests or procedures commonly used without good cause.
The American College of Cardiology, for example, says stress tests are unnecessary for otherwise healthy adults without cardiac symptoms because they rarely result in any meaningful change in patient care.
The American College of Radiology recommends against chest X-rays before outpatient surgery for patients who have normal physical exams and no previous problems because the images do not usually change patient care and have not been shown to improve patient outcomes.
And the American Academy of Allergy, Asthma & Immunology says that because most cases of acute rhinosinusitis can be diagnosed clinically and resolved without treatment in two weeks, there is no need for antibiotics or a sinus CT scan or other imaging.
The lists, which include information about when a particular test or treatment may be appropriate based on clinical evidence and guidelines, are part of the Choosing Wisely campaign, a multiyear effort aimed at reducing the use of unnecessary medicine and promoting greater dialogue between patients and physicians.
The Congressional Budget Office estimates that up to 30 percent of health care expenditures in the U.S. go toward tests, procedures, doctor visits, hospital stays and other services that many medical experts say do not improve patients' health.
"Unfortunately, in some of the political rhetoric about health care costs and all of the accusations about rationing, consumers get understandably worried," said Dr. Christine Cassel, president of the American Board of Internal Medicine and ABIM Foundation, which organized the Choosing Wisely campaign.
Patients "think more is better, and 'Maybe I'm not getting something I need,' when, in fact, more is not necessarily better," she said. "There are a number of things that not only aren't necessary and are potentially costly, but also have a risk of harm to the patient."
The lists cover a wide range of tests, procedures and treatments, some of which are routinely used for thousands, even millions, of patients. Others are only for specific kinds of patients such as those with certain cancers or undergoing kidney dialysis.
For example, the American Society of Nephrology said dialysis patients with limited life expectancies — six months or less — and no signs or symptoms of cancer shouldn't get routine cancer screening, including mammograms, colonoscopies, Pap smears and PSA tests.
The American Society of Clinical Oncology, which is meeting in Chicago this week, recommended against using advanced imaging technologies such as PET, CT and radionuclide scans to determine cancer spread in patients with early-stage breast cancer and prostate cancer that is at low risk of metastasizing.
In both cases, the tests can lead to unneeded invasive procedures, overtreatment, unnecessary radiation exposure and misdiagnosis.
Some outside experts applauded the effort to reduce unnecessary care.
"The greatest advance in medicine in the past 50 years is not the latest wave of good ideas. It's the ability and mandate to ask whether any idea advantages any patient, and if so, how much?" said Dr. Nortin Hadler, author of "Worried Sick: A Prescription for Health in an Overtreated America."
"These lists scratch the surface of good ideas that have proved disappointing at best," Hadler said. "Every patient has the right to ask a physician 'How certain are you that any particular test or intervention will advantage me?' and expect an informative answer."
Others said the campaign has shortcomings.