If you feel you’re poked, prodded and subjected to too many tests when you visit the doctor, your physician may actually agree.
Nine major medical societies, including the American College of Cardiology and the American Society of Clinical Oncology have banded together — representing nearly 375,000 physicians — to promote Choosing Wisely, an initiative aimed at getting doctors to perform 45 commonly used tests and procedures less often and patients to start questioning their doctors about the procedures they’re offered.
The coalition of professional groups, working under the auspices of the American Board of Internal Medicine Foundation, is urging doctors to stop overusing medicine. Many doctors order tests even if they might not be necessary and may even harm the patient, sometimes to protect themselves from potential lawsuits, sometimes because the tests are simply profitable for the physician.
The move is a bold one and, while not binding, it’s a first step toward acknowledging and reining in medical overspending. A large chunk of rising health care costs in the U.S. is due to excessive and unnecessary medical care: some experts say that as much as one-third of our annual $2 trillion in health care spending goes to unneeded tests and hospitalizations, along with unproven and ineffective treatments and heroic but futile end-of-life therapies, according to the New York Times.
Each of the nine professional groups has come up with five tests or procedures that it believes doctors and patients overuse routinely (see here for the full list). The American Gastroenterological Association, for example, is recommending against repeat colonoscopies within 10 years of a normal result from a first colonoscopy for patients with no family history of colon cancer. The American College of Physicians is advising against using MRI to image patients any time they complain of generalized low back pain, and heart experts say doctors should stop using stress echocardiograms in routine check-ups for patients who don’t have chest pain or other risk factors for heart disease or heart attack.
“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?’” Dr. Christine Cassel, CEO of AIBM, told the Wall Street Journal.
Other procedures the groups are urging against: prescribing antibiotics for sinus infections, ordering imaging scans for patients with simple headaches, and treating cancer in end-stage patients who have not responded to other therapies and aren’t eligible for experimental treatments.
The trick is drawing the line between excessive care and appropriate care, which many doctors say has become exceedingly difficult in our litigious society. The more-is-better mentality largely arises from a health care system in which doctors can be sued for malpractice if they make a misdiagnosis or omit certain services. And until that changes, say some, the habit of ordering tests — just to be safe — will be hard to break.