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.”