Doctors: Extra Tests Not Key to Best Patient Care
(NEW YORK) -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.
The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.
The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.
"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital. "Doing tests is not the same as providing care in all instances."
Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many. Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.
Some of the recommendations are not radically different from what other groups have been saying for years. Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.
But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.
"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine. "And it should be just the beginning of a movement."
Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say. Often the reason is simple: a given test or procedure is what the doctor has always done.
Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger. Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.
"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.
But experts say it's time to drop this just-in-case mindset.
Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.
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