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Doctor Groups Unite Against Unnecessary Tests & Procedures

By Richard Knox, NPR News

February 21st, 2013, 11:33 AM

This story comes from our partner ‘s Shots blog.

Doctors do stuff — tests, procedures, drug regimens and operations. It’s what they’re trained to do, what they’re paid to do and often what they fear not doing.

So it’s pretty significant that a broad array of medical specialty groups is issuing an expanding list of don’ts for physicians.

Don’t induce labor or perform a cesarean section for a baby who’s less than full-term unless there’s a valid medical reason, say the American College of Obstetrics and Gynecology and the American Academy of Family Physicians. (It can increase the risk of learning disabilities and respiratory problems.)

Don’t automatically do a CT scan on a child with a minor head injury, warns the American Academy of Pediatrics. (Currently half of all such children get them, when simple observation is just as good and spares radiation risk.)

Don’t try to normalize blood sugar in most diabetic patients over 65, exhorts the American Geriatrics Society. (It can lead to higher mortality rates.)

And on and on. The latest list totals 90 tests and procedures that are often unnecessary and potentially harmful, compiled by 17 specialty groups representing more than 350,000 doctors.

The list is the second chapter in a campaign called Choosing Wisely sponsored by the Foundation of the American Board of Internal Medicine. Last year the foundation warned against 45 tests, procedures and treatments that often do patients no good. That list was endorsed by nine medical specialty organizations.

The new don’ts bring the total to 135.

The idea is to curb unnecessary, wasteful and often harmful care, its sponsors say — not to ration care. As one foundation official pointed out last year, rationing is denial of care that patients need, while the Choosing Wisely campaign aims to reduce care that has no value.

The campaign aims to foster the notion, among patients as well as doctors, “that when it comes to health care, more is not necessarily better,” Dr. Christine Cassel of the ABIM Foundation says in a statement abut the latest list, to be officially unveiled at a Washington media event Thursday.

The sponsors promise even more lists of don’ts later this year from a dozen more specialty groups, ranging from the American College of Surgeons to the American Headache Society.

Here are some other notable tests, traditions and procedures to skip:

Don’t use feeding tubes in patients with advanced dementia. Simply assisting such patients to take food by mouth is better.

Don’t perform EEGs (electroencephalography) on patients with recurrent headaches. It doesn’t improve diagnosis or outcomes and simply increases costs.

Don’t perform routine annual Pap tests in women between 30 and 65. Every three years is enough.

Don’t hold back on providing hospice care to relieve pain and distress just because a seriously ill patient is getting treatment aimed at alleviating disease.

Don’t leave an implantable defibrillator turned on if a patient with incurable disease, or his family decision-makers, have elected to forego resuscitation. Currently there are no formal policies on this issue, and implantable defibrillators often fire in the weeks preceding death, causing pain and distress to dying patients and their families.

Don’t use cough and cold medicines in children under four suffering from respiratory illness. They offer little benefit, can have serious side effects and risk accidental overdose.

Don’t do repeat bone scans for osteoporosis more often than every two years. Healthy women over 67 with normal bone mass can go up to 10 years without a repeat bone scan.

Don’t prescribe benzodiazepines, such as Valium, or sedatives and sleep aids to older adults with insomnia, agitation or delirium. They can more than double the risk of motor vehicle accidents, falls, hip fractures and death.

Don’t screen patients routinely for vitamin D deficiency. Over the counter supplements without laboratory testing is sufficient for most otherwise healthy patients.

Don’t screen for cancer in healthy individuals using CT or PET scans. The likelihood of finding cancer is around 1 percent, and the scans are likely to identify harmless findings leading to more tests, biopsies or needless surgery.

11 Responses to “Doctor Groups Unite Against Unnecessary Tests & Procedures”

  1. Harry says:

    Unnecessary tests and procedures are what has traditionally turned doctors into multi-millionaires. By “self-policing” their ranks and eliminating the gravy, aren’t the doctors cutting their own collective throats? Or maybe they see the handwriting on the wall and are trying to get ahead of the curve by admitting to the “pork” they have enjoyed for so many decades before Obamacare does it for them? Fact is, these unnecessary tests and procedures have made doctors FAT for a very long time and nobody has made them accountable. Nobody has ever questioned the authority of a doctor. They have enjoyed prima donna status for a very long time. With Obamacare, doctors will be under the microscope. They will be forced to be more accountable. They will be forced to compete with better doctors. Doctors and hospitals will be under serious scrutiny going forward. I guess the party is over, huh?

  2. anne sulli says:

    Totally agree! Glad someone finally said it….

  3. Gladys says:

    I am so glad that someone has made it known what most patients have felt for a long time.
    Doctors do make so much money from treatments and med. It time someone was looking out for the parients .I agree with leting the people know whats is really important and whats not .

  4. Kathleen says:

    I read these comments with interest, and want to offer a different, additional reasons that many tests are ordered. First, many, many patients come to see the doctor and request (even demand) tests be done when not essential. This is similar to patients requesting antibiotics when the doctor suspects a viral infection. One can point out that the test is not necessary, not appropriate, and that another test might do a better job to evaluate the symptoms at hand. Yet this does not help in many situations. I am happy to see that now patients are more careful stewards of their “first dollars” and are less demanding than when 3rd party payers ante up for every test. But this was one of the desired outcome of high deductible health plans, wasn’t it? Second, we live in an extremely litigious society that understandably scrutinizes every step of an evaluation if an outcome should be undesired (a cancer, say, or an infection). No physician ever wants to be in the position to have missed the “worst case scenario”. Even though we all want to see adherence to accepted guidelines such as these, there will be patients who have bad outcomes…why didn’t you do the test, Doctor?

  5. AT89 says:

    As a healthcare provider, I have often been horrified and dismayed at the lengths patients and their families will go to prolong life. I have seen countless elders being essentially tortured in their final weeks and days by painful, unnecessary and futile tests and procedures. Many times this is at the request (demand) of the family, or is the “default” when patients do not have advanced directives in place. All patients and care providers need to understand and modify their practice in accordance with the philosophy that just because something CAN be done, does not mean that it SHOULD be done. I am very happy to see an organization like Choosing Wisely is stimulating this extremely important discussion about our national healthcare system and how best to prioritize increasingly limited resources.

  6. Helen says:

    The above two posts are important and worthy of consideration, but we can’t keep allowing patients (or family) to insist upon being the doctor. That is why we need an absolutely rigid set of standards for care and anything outside of those standards should not be covered. This especially applies to Medicare and Medicaid. I think we can all agree that every patient is entitled to a 2nd opinion because no healthcare professional is perfect 100 percent of the time regarding diagnosis. However, beyond a 2nd opinion and beyond a rigid set of industry approved standards should only be available if the patient (or family) pays the “full” cost themselves. The Patient Protection and Affordable Care Act provides for standards of essential benefits. If a patient (or family) wishes heroic efforts to maintain life for another day or two and that kind of care is outside the purview of essential benefits, then all of the tests and procedures outside of the essential benefits coverage should be assumed by the patient or their family. The healthcare professional should only be held accountable for providing standardized essential care. If someone is deemed terminal and a 2nd opinion confirms that diagnosis, the patient should be offered palliative care and/or hospice care and that kind of care should be covered. Those against this concept need to understand that death is a natural part of the life cycle. Only the brainless think they are immortal.

  7. Mark says:

    It may be true that there are doctors who over utilize for profit, but in my experience patients are by far more interested in doing more now instead of waiting to see how things go. Every month I see patients come in demanding MRI’s for what 90% of the time is arthritis. My pediatrician laments that patients parents bring their children with colds (a viral infection) and demand antibiotics.
    All doctors are not getting “fat” on medicines or treatments. Family practice doctors, pediatricians and internal medicines doctors have been long undervalued and payments have actually decreased since doctors did well in the 70′s and 80′s.
    Patients who have to pay for their non catastrophic health problems will care enough to learn about their health, do things to improve it and make the intelligent decision to rely on their doctors education for advice.

  8. perry says:

    Seriously? Do you know what doctors make for ordering tests? Nothing. Not unless they own the lab or test equipment, and if they do, they are regulated in use. Whether a test is ordered because it’s standard, which is most common, or if it is because of patient demand, or if it is because a doctor is worried about liability, does not mean doctors get a dime for writing the script or the order. Look at the bill for the service–again, unless lab or machine is owned by the practice, the bill will be independent.
    As a doc, I have no financial incentive, contrary to the popular belief, to order tests other than for clinical need, defensive medicine, or demanding patients. Even better, I have to take the trouble to order it and am responsible for getting it authorized by insurance and following up on the results, for not a cent more than if I never ordered it. Why, when my time is valuable to me, and means I can see more pts if I spend less time on paperwork and authorizations, would I want to order a darn thing more than I had to? Pet peeve is patients who demand the services and don’t actually have to pay for them… someone is paying, usually the taxpayer, who is most of us. There is so much wrong in healthcare in this country, but let’s please not spread the lie that testing is usually of financial benefit to the doctor. To the hospitals, yes, but we are not them.

  9. bud says:

    Hey doc,

    Then why do I see so many well dressed sales representatives sitting in my doctor’s office waiting to see my doctor? Are you saying that my doctor has the spare time to see these people for free? Are you saying that these visits are not profitable to someone if some way?

  10. bud says:

    In my opinion, if you aren’t taking any perks, you are one in a million! I’m amazed that you would suggest that the healthcare industry is without corruption.

  11. Sandra says:

    As a current RN and a former pharmaceutical rep, I can say that I have seen physicians on both sides of this fence. Many physicians will order unnecessary tests, but oftentimes, it is at the request of the patient or the family members. In a preceding comment, there is mention of our society being “litigious,” and I agree with this 100%. I work in an ER now, where we have physicians that will do a million dollar work-up on a patient because they don’t want to miss the “worst case scenario” especially when the patient and/or the family member is threatening to sue for what they feel is neglect. For example, there have been many times when a young, healthy 20-30 something year old with no prior history presents with chest pain. 99% of the time, the pain is not cardiac in nature. However, for fear of being sued by the patient, the physician will order a cardiac work up (EKG, labs, chest xray, etc…)- both to appease the patient and to avoid the worst case scenario. No, our physicians do not receive kick backs for labs and tests, but there is a “quarterly bonus” given to physicians based on the number of patients they see.

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