Last week, the American Board of Internal Medicine Foundation announced the results of the Choosing Wisely initiative, which asked specialty societies to publicize their own specialties’ most over-used tests and treatments. Here are some examples:
-Routine CT scans and antibiotics for uncomplicated sinusitis NOT RECOMMENDED.
-Xrays for back pain of less than 6 weeks in duration without neurologic signs or symptoms NOT RECOMMENDED.
-ECG Treadmill testing in individuals without symptoms as a screening test NOT RECOMMENDED
-Routine pre-operative chest Xrays in patients without symptoms under age of 70 NOT RECOMMENDED
-CT Scans to diagnose appendicitis in children NOT RECOMMENDED as first test (ultrasound should be done first with CT only if ultrasound inconclusive)
-Long-term antacid therapy for people with simple Gastroesophogeal reflux disease (GERD). NOT RECOMMENDED. Doses should be minimized as soon as symptoms are controlled.
While this was developed primarily for physicians, it is a great “conversation starter” for patients as well. We at Good Medicine encourage all patients to ask 4 questions when their doctor recommends a test or treatment:
1. Has this test/treatment been proven to extend the life-span of patients like me?
2. How long has this test /treatment been around?
3. What are the down-sides of having this test/treatment?
4. * What is the chance that I actually have the disease if the test is positive? (*for screening tests).
Asking questions and starting a conversation is the first step on the road to Shared Medical Decision Making, and the ideal doctor-patient relationship. Moreover, Choosing Wisely uncovers a lot of unnecessary testing and treatment that we all need to address if health care will ever be as cost-effective and safe as it should be. Many consumers have reacted to this list as a “health care rationing/cost-saving initiative” and while its aim is to reduce cost, it is also to improve patient safety. Remember: every drug has a side effect profile and many imaging studies add to your lifetime dose of radiation. Furthermore-a test that shows an abnormality will lead to more tests and treatment that might not be necessary. Still, at the end of the day, these are “public health” recommendations. Each individual in partnership with their doctor, has to decide what’s right for them.
Check out the full list here
PS The image above, a chest xray was included in the list. Check it out to see for yourself!
Sources: MedPage Today April 4, 2012
American College of Radiology: Appropriateness Criteria revised 2011.
http://choosingwisely.org/ (American Board of Internal Medicine Foundation)