A group of nine medical societies organized by the American Board of Internal Medicine Foundation have compiled lists of unneeded medical tests, treatments and procedures that drive up healthcare costs in an effort to cut down on waste.
The initiative, called “Choosing Wisely,” includes recommendations from the American Academy of Allergy Asthma & Immunology, American Academy of Family Physicians, American College of Cardiology, American College of Physicians, American College of Radiology, American Gastroenterological Association, American Society of Clinical Oncology, American Society of Nephrology and the American Society of Nuclear Cardiology.
Each group compiled five tests, procedures and treatments that could be used more selectively or modified.
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The movement was spurred by a desire to get input from physicians on how healthcare reform could work. Eight more specialty societies are expected to compile similar lists that will be announced this fall.
Daniel Wolfson, the executive vice president of the American Board of Internal Medicine Foundation in Philadelphia, who also contributes to The Medical Professionalism blog, said it was not about rationing care but about using better judgment. “This is about things that are being done that are not necessary. Physicians are interested and excited that these conversations are going on.” He added that “there are no absolute rules with these tests.”
The lists included frequent references to imaging such as for procedures like preoperative X-rays and imaging scans for patients with lower back pain or headaches who do not exhibit red flags that could indicate a serious illness.
Imaging for patients with headaches or low back pain. Unless there are specific disease risk factors, physicians shouldn’t do imaging for headache patients because it probably won’t improve the outcome. Low back pain is the fifth most common reason for physician visits. Imaging for patients with this condition, if no red flags are triggered, should not be ordered within the first six weeks because it drives up costs.
X-rays. Preoperative chest X-rays should not be done without a specific reason found from the patient’s history or physical exam. Only 2 percent of preoperative X-rays lead to a change in how the patient is treated.
MRI and CT scans. When a patient faints, a scan shouldn’t be done unless he or she has had seizures or shows other neurological symptoms or signs.
Cardiac imaging. Low-risk patients should not be given stress cardiac imaging or coronary angiography. Asymptomatic, low-risk patients account for up to 45 percent of inappropriate stress testing. The test should only be given to people with diabetes, who are older than 40 and patients with peripheral artery disease. It also said it’s not useful to do noninvasive testing for patients undergoing low-risk noncardiac surgery or with no cardiac symptoms or clinical risk factors undergoing intermediate-risk noncardiac surgery.
Chronic dialysis. Chronic dialysis for older adults shouldn’t be without a group decision-making process between patients, their families and their physicians because it would not substantially increase their survival.
Electrocardiograms. The potential harm that can stem from ordering annual electrocardiograms for low-risk patients is not worth the risk. A false positive result could lead to unnecessary invasive procedures, overtreatment and misdiagnosis.
[Stockxchng photo from Max Brown]
