Unnecessary?: A MRI scan does not affect treatment or improve outcomes any faster for patients—but it can lead to radiation exposure and unnecessary surgery.
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The routine use of 130 different medical screenings, tests and treatments are often unnecessary and should be scaled back, according to 25 medical specialty organizations. The medical societies jointly released lists of tests and therapies patients should question in their campaign, Choosing Wisely. The initiative of the American Board of Internal Medicine Foundation is aimed at reducing unnecessary interventions that waste money and can actually do more harm than good.
A 2012 report by the Institute of Medicine estimated that $750 billion—about 30 percent of all health spending in 2009—was wasted on unnecessary services and other issues, such as excessive administrative costs and fraud. Many of those unnecessary services appear on the new lists released in February from Choosing Wisely. An additional 90 medical services were added to the 40 items initially listed by the campaign in April 2012.
Some of the items on the lists are familiar. Patients should avoid scheduling nonmedically indicated labor inductions or cesarean sections before 39 weeks, for example. Others are designed to reduce the use of expensive and often unnecessary imaging tests, such as early use of magnetic resonance imaging (MRI) or computed tomography scan (CT) scans for complaints that will likely go away on their own. For example, the American Academy of Family Physicians (AAFP) recommends that unless red flags are present, doctors should wait six weeks to order imaging for low back pain. The scans do not affect treatment or improve outcomes any faster for patients—but it can lead to radiation exposure and unnecessary surgery.
Other list items may surprise patients. The American College of Obstetricians and Gynecologists recommends that women 30 to 65 years old who are not at high risk for cervical cancer skip the annual pap smears; the research shows that conducting screenings every three years works just as well.
The idea that excess tests are unhelpful is not new. Charles Tullius, an anesthesiologist at South Pittsburgh Anesthesia Associates, says members of his profession stopped doing many routine preoperative tests decade ago because they led to too many false positives that did nothing but delay surgery. “A lot of these screening tests are fishing expeditions,” he says. “They’re very low-yield.” It’s worse than that: it is becoming clear that many once-routine tests may actually cause harm. But the idea of a test causing harm can be difficult for people to wrap their heads around.
More care isn’t better care
“We are, I hope, at a turning point in American health care where we’re realizing you want to have the right health care, not just more health care,” says Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chair of the U.S. Preventive Services Task Force. Moyer points out that mammography use is responsible for about 20 percent of the cases of overdiagnosis of breast cancer. In fact, the Task Force came under fire a few years ago for recommending fewer women receive routine mammograms—even though the recommendation was based on evidence about providing the best care to women. “As our diagnostic tests get better and better, we can find all kinds of things that are of no consequence,” Moyer says. “If you find something that wasn’t going to hurt you during your lifetime and you treat it, it can only hurt you.”
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11 Comments
Add CommentIt seems to me that a major part of the problem is that doctors now treat consumers instead of patients. Most doctors are in a commercial enterprise whose end purpose is to pay off educational debt and to acquire personal wealth.
Reply | Report Abuse | Link to thisI think it is common practice for doctors to purchase their own equipment to perform these tests in order to increase their own profits. This represents a conflict of interest that is unethical and should be illegal.
It is so hard these days to find a doctor that really wants to help his/her patients get well.
I remember when docs began to ramp up testing when malpractice awards began to skyrocket then it's morphed into a business as outlined in the article. We've got to slow down and not demand services that are not goal oriented. Docs need to read the handwriting on the wall before the government really steps in to control costs.
Reply | Report Abuse | Link to thisNot all of this can be blamed on the doctors. I know multiple physicians that have complained about having to jump through multiple hoops to try to do the best thing for the patient.
Reply | Report Abuse | Link to thisFor instance many insurance companies refuse to cover an MRI unless the physician orders a CT scan first (regardless if the MRI is the better test for the situation) because the CT is cheaper for them. Even if the Dr. knows the CT probably wont show them what they want to know, they have to order it first so a patient doesn't have to pay out of pocket for the test they actually need but couldn't afford.
Plus, the constant threat of a malpractice suit has pushed the medical community towards aggressive testing. It's now safer for a physician to over-test to be thorough, than to risk being sued and accused of negligence. It's great to teach patients that not all tests are necessary. I doubt that a malpractice lawyer will see it that way, however.
Don't get me wrong, I agree with the article that the usefulness/consequences of tests should be viewed objectively. I also feel national guidelines should reflect the facts. My objection is when the blame is placed solely on the shoulders of the physician. Malpractice threats and insurance obstacles have far more influence on this than people realize.
MRI scans do not subject patients to ionizing radiation as the caption on your image tends to suggest.
Reply | Report Abuse | Link to thisI am thrilled to see this article,especially following the Times article "Bitter Pill" yesterday. This kind of information hasn't made it to the mainstream TV news but hopefully with nudges from quality journalism, it will. The culture of "What's your colesterol count" and "Have you had your colonoscopy" and "there's a pill for that" needs to change. We are overtreated and underserved by the medical system comprised of physicians, hospitals, big Pharma, medical device manufacturers and insurance companies. We can help stop this by refusing unnecessary testing and treatments. Your insurance may pay it, but what are you paying for your insurance? What are we all paying?
Reply | Report Abuse | Link to thisBooks written on the lack of a free market in the medicalization of our society are plentiful, but most people don't read nonfiction books. That's why I'm so excited by these articles. If you really want to get revved up by this topic, read "Bad Science", "Overdiagnosed", "Catastrophic Care", "Worried Sick", and "Doctor, Your Patient Will See You Now".
Few of the players in this game are evil - but many are greedy. Educate and protect yourself.
Thank you, Scientific American, for this article.
Who is paid to keep people healthy? No one.
Reply | Report Abuse | Link to thisWho shops for medical care? Pretty much now one.
Where do you go for information on the quality of your hospital or physician? Damned if I know.
MRC06405 : you put your finger on it. One answer should be : the insurance companies. But do they have an incentive to reduce costs, or are their profits a function of total expenditure?
Reply | Report Abuse | Link to thisAnd to be fair, they are plagued as well by law-suits and the courts.
No doubt the high cost of malpractice insurance is a key reason for imposing expensive, often unnecessary tests on patients. The bottom line is that although we have available in the US an extraordinary arsenal of tests and drugs we are far back on the list of medical results or quality; 27th worldwide I believe. We provide or have available the best medical care and equipment and we do so poorly in terms of outcomes. Incredible! A second reason is that there are among our medical professionals a small cadre of real dum dums who should not be allowed to practice. If our doctors rose up and demanded that they be removed or otherwise made them non practicing by speaking out, the high cost of malpractice insurance would be eliminated. Lawsuits that result when things go awry should have very limited awards so as to reduce the number and cost of such lawsuits. This would also reduce the cost of malpractice insurance. Once that is accomplished the number of unnecessary or marginal tests would be reduced and the need for high performance test equipment would be reduced. Why do we annually kill 100,000 hospital patients and cause 2 million infections annually by use of totally ineffective hand sanitation means? The associated cost is $40 billion. Why do nurses and doctors use ineffective alcohol rubs to sanitize their bare hands and moreover do it less than 50% of the time, doing nothing to sanitize hands between patients the rest of the time. It is not as if there is not an ultrafast, 1000 times more effective, 20 times less costly means to sanitize bare and gloved hands between patient visits. Something is very fishy in Denmark USA.
Reply | Report Abuse | Link to thisDr's are regularly sleep deprived .
Reply | Report Abuse | Link to thisThey of all people know that is not a good thing for themselves or their patients .
Better decisions will be made when a proper sleep pattern is a requirement !!!
I attest to having Cigna, my insurer, mandate that I got CT scans before then getting MRIs for conditions in which the standard for care medically is an MRI. The attempt to save money is wasteful and nonsensical. Is the insurer dictating my diagnostic and treatment protocol or is the doctor? If the patient protests, then the patient becomes "non-compliant," according to some attorneys. A system run by non-medically educated insurance executives has proven to deliver less than adequate medical care. Pennywise and pound foolish wasting both patient and doctor time doing what both know makes no sense other than to please the payer.
Reply | Report Abuse | Link to thisI was baffled learning that I had to run through a checklist of standard tests to "rule out" possible illnesses before any specific tests could be run to address my health complaint. I changed primary care physicians three times and each time encountered these same battery of tests (which had nothing to do with my complaint. All came out negative because I am not overweight, work out, eat healthy. The doctors then said that I must be all right since their tests (none designed to address my complaint) were all negative. I then learned most conventional doctors have no training in detecting systemic fungal infections, hypothyroidism, adrenal fatigue, food sensitivities, autoimmune diseases... When does listening to the patient's concern ever enter the picture?
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