Now there are 135. That’s how many medical tests, treatments and other procedures – many used for decades – physicians have now identified as almost always unnecessary and often harmful, and which doctors and patients should therefore avoid or at least seriously question. According to the story in Reuters Health, the lists of procedures, released on Thursday by the professional societies of 17 medical specialties ranging from neurology and ophthalmology to thoracic surgery, are part of a campaign called Choosing Wisely. Organized by the American Board of Internal Medicine’s foundation, it aims to get doctors to stop performing useless procedures and spread the word to patients that some don’t help and might hurt.
“Americans’ view of healthcare is that more is better,” said Dr Glenn Stream, a family physician in Spokane, Washington, and board chairman of the American Academy of Family Physicians, which has identified 10 unnecessary procedures. “But there are a lot of things that are done frequently but don’t contribute to people’s health and may be harmful.”
For the most part, the medical specialty groups did not consider cost when they made their lists. If their advice is followed, however, it would save billions of dollars a year in wasteful spending, said Dr John Santa, director of Consumer Reports’ Health Ratings Center and a partner in Choosing Wisely. One large medical group with 300,000 patients, Santa said, calculated that following the Choosing Wisely advice on just two procedures, superfluous EKGs (electrocardiograms) and bone-density scans, would reduce its billings by $1 million a year. Nationally, that translates into some $1 billion in savings.
The medical specialty groups each came up with five procedures to “question,” but most of the items begin with an emphatic “don’t.” The targeted procedures range from the common to the esoteric. Anyone who has ever had surgery while in generally good health can sympathize with the recommendation against multiple pre-op tests: Ophthalmologists now advise against EKGs and blood glucose measurements before eye surgery, except for patients with heart disease or diabetes.
Physicians recommend against many procedures patients have come to expect, including imaging for low back pain (unless it has lasted more than six weeks) and any cardiac screening, including EKGs, in patients without heart symptoms.
The widely used “DEXA” X-ray screening for osteoporosis landed in rheumatologists’ crosshairs. It should not be done more than once every two years, they advise, because changes in bone density over shorter periods are typically less than the machines’ measurement error, which can cause women to think they’re losing bone mass when they’re not.
If doctors adopt the recommendations of their specialty, doctor visits for some chronic diseases would be very different. Patients with recurrent headaches would not get EEGs (electroencephalography); they don’t improve outcomes. And rheumatologists would not use MRIs to monitor joints in patients with rheumatoid arthritis; a clinical assessment is just as good.
Many business groups have signed on to Choosing Wisely, hoping it will reduce soaring healthcare costs. For instance, the National Business Council on Health, with 7,000 employer members, and the National Business Group on Health, representing Fortune 500 companies and other large employers, are distributing to their members educational material developed by Consumer Reports, a partner in Choosing Wisely. They are careful to emphasize that the advice comes from doctors. “If employers say you shouldn’t have all these tests or procedures, it’ll inevitably be seen as ‘my employer doesn’t want to spend the money to cover them,'” said Helen Darling, president of the Business Group.
The pages and pages of lists raise an obvious question: How did so many worthless and even dangerous procedures become so widely used? For one thing, there is no regulatory requirement that physicians prove a new procedure helps patients, as drug makers must do before selling a new pharmaceutical. For another, “Americans want the latest, newest thing,” said Dr Howard Brody of the University of Texas Medical Branch, whose 2010 challenge to physicians to identify worthless tests and treatments inspired Choosing Wisely. “Technological enthusiasm on the part of physicians and the general public makes them willing to adopt new things without rigorous testing. Only years later, and only if studies are done, do we see that it’s no good.”