Some tests are life-savers, but some are worthless. A campaign called Choosing Wisely has been launched by nine national medical groups, with the goal of getting U.S. doctors to tell the difference. Specifically, Choosing Wisely wants health care providers to back of on 45 diagnostic tests, procedures and treatments that range from harmful to merely useless.
CT scans, MRIs and X-rays comprise many of the 45. For example, they recommend that if a child comes into the emergency room with low belly pain and appendicitis, do an ultrasound before a CT scan. That will provide an answer 94% of the time, plus it’s cheaper, plus it doesn’t expose the child to radiation.
It’s not just actual tests that this covers, though — the groups also suggest that, for example, if a patient has heartburn, avoid high doses of acid-suppressing drugs since lower and shorter courses will do the job. The high dose might actually make symptoms worse once the patients try to stop the medicine.
An apparently healthy middle-aged guy with few cardiac risk factors comes in for a yearly exam and wants to know how his ticker is. Don’t give him a full cardiac workup, with a treadmill test and fancy imaging. This kind of patient accounts for almost half of unnecessary cardiac screening.
Postpone repeat colonoscopies for 10 years if the first one is negative, or if it found and removed one or two early-stage colon polyps, the guidelines state. And stop prescribing antibiotics for mild-to-moderate sinus infections.
And here’s one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn’t get more chemotherapy.
“When somebody is literally bed-bound and unable to walk or take care of himself, it’s almost futile to use cancer-directed treatment and will probably have negative consequences,” says Dr. Lowell Schnipper, a Boston cancer specialist who helped develop the new guidelines.
Schnipper tells Shots many cancer patients are getting chemotherapy in the last weeks of their lives. He says that does no good, makes patients miserable and may shorten their life.
The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures “whose necessity … should be questioned and discussed.”
The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.
Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.
Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.
The effort represents a growing sense that there’s a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.
Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.
“That’s certainly the number we use,” Dr. Steven Weinberger, CEO of the American College of Physicians, tells Shots. “Most of us feel something like $750 billion or so could be eliminated from the system out of the $2.5 trillion or so that we spend on health care.”
Weinberger says unneeded diagnostic tests probably account for $250 billion.
“I talk about this a fair amount around the country, and invariably physicians come up to me and recount their own anecdotes about overuse and misuse of care,” he says.
Proponents of the campaign are aware they’re wading into dangerous waters. “There will be some … that may demonize this campaign and infer the R-word — rationing,” Daniel Wolfson of the ABIM Foundation wrote in December when the campaign was launched.
But rationing is the denial of care that patients need, Wolfson points out. The Choosing Wisely campaign aims to reduce care that has no value.