Many Medical Tests and Procedures Aren’t Needed — Doctors’ Groups

By Anna Wilde Mathews,

  • April 4, 2012, 8:24 AM  WSJ Health Blog
  • Many medical tests and procedures are performed when they aren’t needed, a new campaign by several doctors’ groups says.

    The initiative, coordinated by the foundation affiliated with the American Board of Internal Medicine, will initially focus on 45 medical services — five each produced by nine different doctor-specialty societies. It will later add future lists from other specialties.

    The lists will be publicized by Consumers Union’s Consumer Reports, AARP and other consumer groups, says Dr. Christine Cassel, the foundation’s CEO.

    “We’re not saying they should never be done, we’re saying these are often unnecessary, and therefore the patients should ask the doctor, ‘Gee, do I need this?’” Cassel tells the Health Blog.

    The campaign, dubbed “Choosing Wisely,” comes amid intense pressure to rein in growing health-care costs. Doctors are trying to take the initiative from insurers.

    “We’re better positioned to do this than insurance companies,” Cassel says.

    Many of the examples on the initial lists, such as imaging scans, focus on services and situations that have long drawn concern about overuse.

    The American Society of Nuclear Cardiology noted several circumstances in which cardiac imaging wasn’t typically necessary. For instance, it said, patients with chest pain who are at low risk of cardiac death or a heart attack don’t typically need stress echocardiography. The American College of Radiology said doctors often shouldn’t do imaging for uncomplicated headaches. The American College of Physicians said imaging studies aren’t usually needed for non-specific lower-back pain.

    Some of the suggestions may spark debate. The American Academy of Family Physicians says antibiotics shouldn’t routinely be initially prescribed for acute mild or moderate sinus infections. Yet doctors say they often come under pressure from patients with sinus symptoms who want to be prescribed antibiotics.

    Likely to be touchier is the recommendation from the American Society of Clinical Oncology that doctors should typically steer away from chemotherapy or radiation therapy for patients with solid tumors who aren’t doing well, don’t qualify for a research trial, haven’t responded to multiple past treatments and show no strong evidence that they will benefit from new ones.

    Instead, such patients may do better with palliative care aimed at easing their pain and other symptoms, says Dr. Lowell Schnipper, the chairman of the society’s task force on the cost of cancer care and a professor at Harvard Medical School.

    The decision has to be up to individual patients and doctors, Schnipper says, but it’s important to “help the patient understand that more cancer-directed treatment is not likely to be helpful” under those circumstances.

    Indeed, research has shown that it may lead to shorter survival times than the palliative therapy, he said.