Doctor groups urge patients to question some medical tests
April 04, 2012
by Brendon Nafziger, DOTmed News Associate Editor
Coming back from a recent trip to China, Daniel Wolfson stopped by his doctor's office for a routine check-up. His doctor told him he needed to get a baseline electrocardiogram to see if his heart was OK. This didn't sit right with Wolfson. "I said, 'No, I don't. I just don't need one. I run four times a week. My heart is great.'" But his doctor prevailed on him to get it.
If only he had a piece of paper stating doctors' groups are not recommending this, things might have been different, Wolfson notes. And he might soon receive that paper.
Wolfson is executive vice president and COO of the American Board of Internal Medicine Foundation. Last year, the organization launched the Choosing Wisely campaign to help start a conversation among doctors and patients about medical over-utilization.
On Wednesday, the project started to bear fruit. Nine specialist societies partnering with Choosing Wisely released a list of 45 frequently overused tests, treatments or procedures that doctors and patients should talk about before ordering to make sure they are appropriate. Among these are antibiotics for sinusitis, annual stress tests in patients without cardiac symptoms and scans for non-specific low back pain.
Oh yeah, and annual EKGs for low-risk patients without symptoms.
"There's potential harm in doing things that are unnecessary," Wolfson said.
The specialist societies, which include the American College of Cardiology, the American College of Radiology and the American College of Physicians, had committees and boards meet over the past year to each come up with five commonly used tests or therapies that doctors and patients should question.
"These are not 'never do' this lists. These are things that should be questioned. Sometimes they are appropriate," Wolfson said. "It's not an absolute."
Consumer Reports will translate the material worked up by the societies into lay language to make it easier for patients to understand. They will be helped by almost a dozen consumer groups, business coalitions and unions who have agreed to pass the information on to their members, such as the AARP, the SEIU and even Wikipedia.
The hope, as Wolfson explains, is to create conversations: between doctors, between patients and doctors, and even with payors, government and delivery systems.
"We've got to address issues of inappropriate care. These things cost money, and if they don't have value it's not a good thing for building a sustainable health care system," Wolfson said.
Wolfson said that this fall another eight specialist societies, including the Society of Nuclear Medicine, will release their lists of potentially overused procedures.
For now though, Consumer Reports should be releasing a prototype of the sort of patient-friendly material patients can bring to their physicians to discuss procedures. As for Wolfson, he has already made at least one change.
"I did change my doctor," he said.
Things to question
The physician groups, which together represent more than 375,000 doctors, suggest questioning procedures including:
For the full list, visit www.choosingwisely.org.
The physician groups participating in this round include the American Academy of Allergy, Asthma and Immunology, the American Academy of Family Physicians, the American College of Cardiology, the American College of Physicians, the American College of Radiology, the American Gastroenterological Association, the American Society of Clinical Oncology, the American Society of Nephrology and American Society of Nuclear Cardiology.
If only he had a piece of paper stating doctors' groups are not recommending this, things might have been different, Wolfson notes. And he might soon receive that paper.
Wolfson is executive vice president and COO of the American Board of Internal Medicine Foundation. Last year, the organization launched the Choosing Wisely campaign to help start a conversation among doctors and patients about medical over-utilization.
On Wednesday, the project started to bear fruit. Nine specialist societies partnering with Choosing Wisely released a list of 45 frequently overused tests, treatments or procedures that doctors and patients should talk about before ordering to make sure they are appropriate. Among these are antibiotics for sinusitis, annual stress tests in patients without cardiac symptoms and scans for non-specific low back pain.
Oh yeah, and annual EKGs for low-risk patients without symptoms.
"There's potential harm in doing things that are unnecessary," Wolfson said.
The specialist societies, which include the American College of Cardiology, the American College of Radiology and the American College of Physicians, had committees and boards meet over the past year to each come up with five commonly used tests or therapies that doctors and patients should question.
"These are not 'never do' this lists. These are things that should be questioned. Sometimes they are appropriate," Wolfson said. "It's not an absolute."
Consumer Reports will translate the material worked up by the societies into lay language to make it easier for patients to understand. They will be helped by almost a dozen consumer groups, business coalitions and unions who have agreed to pass the information on to their members, such as the AARP, the SEIU and even Wikipedia.
The hope, as Wolfson explains, is to create conversations: between doctors, between patients and doctors, and even with payors, government and delivery systems.
"We've got to address issues of inappropriate care. These things cost money, and if they don't have value it's not a good thing for building a sustainable health care system," Wolfson said.
Wolfson said that this fall another eight specialist societies, including the Society of Nuclear Medicine, will release their lists of potentially overused procedures.
For now though, Consumer Reports should be releasing a prototype of the sort of patient-friendly material patients can bring to their physicians to discuss procedures. As for Wolfson, he has already made at least one change.
"I did change my doctor," he said.
Things to question
The physician groups, which together represent more than 375,000 doctors, suggest questioning procedures including:
- Pre-operative chest X-ray unless the patient's history or a physical exam warrants it.
- Scanning patients with uncomplicated headache or who have fainted, absent other risk factors
- Giving women under 65, or men under 70, DEXA scans to screen for osteoporosis, unless they have other risk factors.
- Performing PET, CT or radionuclide bone scans to stage low-risk early breast or prostate cancer.
- Routine cancer screening for dialysis patients who don't have long to live and who have no symptoms.
For the full list, visit www.choosingwisely.org.
The physician groups participating in this round include the American Academy of Allergy, Asthma and Immunology, the American Academy of Family Physicians, the American College of Cardiology, the American College of Physicians, the American College of Radiology, the American Gastroenterological Association, the American Society of Clinical Oncology, the American Society of Nephrology and American Society of Nuclear Cardiology.