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Choosing Wisely

woman-thinking-mdLast week nine prominent physician groups, led by the American Board of Internal Medicine, released a list of 45 common tests and treatments that  research indicates often have no benefit, and could even harm patients.  They have embarked on a campaign entitled: “Choosing Wisely,” that urges  doctors and patients to  work together to question and challenge the use of these tests and to carefully consider whether they are truly needed, based on each individual situation.

Read this article for more information: Choosing Wisely Campaign Aims To Cut Use of Unnecessary Medical Interventions

The Choosing Wisely campaign is aimed primarily  at providers.  It  suggests  that the tests and procedures considered standard, that many providers view as evidence -based best practices, are really not. The  message to providers is that  they  need to stop and think carefully before ordering tests by weighing a patient’s age, risk factors and other variables. A study in the  September 2011 issue of the Archives of Internal Medicine found 80 percent of surveyed doctors said they order some tests that may not be necessary out of fear they might get sued for malpractice.  The campaign suggests that this is not appropriate.

Read this article for more information: Physicians’ Views on Defensive Medicine: A National Survey

Choosing Wisely is also aimed at patients, urging  that they  become more active  participants in their care; educate themselves about tests and procedures that their doctors are ordering;  engage in discussions with their providers about whether or not these tests are  really necessary.This discussion should be a standard part of patient/physician interaction during the office  visit.  A 2010 Consumer Reports survey of 1,200 healthy adults showed that almost 50 percent of them had received screening tests for heart disease that were considered “very unlikely or unlikely to have benefits that outweigh the risks,” reinforcing the need for evaluating the wisdom of so much testing.

Read this article for more information: Rating Heart Risk Tests

The 45  tests and procedures in question include: routine and exercise  electrocardiograms (stress tests), routine x-rays for  low risk ambulatory patients, antibiotics for mild sinus infections, pap smears for low risk or young women, DEXA for osteoporosis,  x-rays and other scans for headaches and low-risk back pain,  and chemotherapy for patients with advanced solid-tumor cancers who are unlikely to benefit.  They have been carefully vetted by specialists from the nine societies who are participating in the Choosing Wisely campaign and who all  agree that more careful deliberation is critical. For a specific list of the Societies go to

Here’s a link to the Choosing Wisely website.

Aside from  the fact that the specific 45 tests and procedures may have no benefit to patients, and could  even harm them, there is a huge financial impact.  Unnecessary testing  accounts for  $2.6 trillion dollars that Americans spend annually on health care.  This money could be used in so many beneficial ways for patients.  Additionally, the high cost of wonderful new medical treatments now available, far exceed our nation’s ability to pay for them  now and in the future.  So how do we achieve a balance?

Read this New York Times article for more information: Do You Need That Test?

Although some might argue that eliminating these tests is a form of rationing health care, unnecessary testing is all about making choices. Physicians need  to be more deliberate in deciding the best way to treat their patients.  Patients need to understand the pros and cons of a specific treatment approach and  collaborate with their physicians to decide on how to proceed.  Many Americans engage in a kind of voluntary self-rationing.  Some choose  living wills  where they instruct loved ones not to expend family funds and taxpayer money to keep them alive by extraordinary means. There are cancer patients,who,  faced with very slender odds of survival, choose palliative care  rather than embracing  more aggressive costly  therapies, even if covered by their insurance. Choosing Wisely merits close attention because it is a way to eliminate unnecessary costly testing while helping us reign in and reduce costs.

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