Does a person having knee surgery need a pre-operative chest X-ray? Do patients need brain imaging scans after fainting? In both cases, probably not. Still these tests are routinely ordered.
Nine leading physician specialty societies have released lists of specific tests or procedures that they say are commonly used but are not always necessary in their respective fields. It is part of the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign.
"These societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed," Dr. Christine Cassel, president and CEO of the foundation, said in a written statement. "Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists kick off important conversations between patients and their physicians to help them choose wisely about their health care."
Chuck Moran, media relations director for the Pennsylvania Medical Society, said he believes the society would agree with the campaign.
"Choosing Wisely aims to promote conversations between physicians and patients by helping patients choose care that is: supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary," Moran said in an email. "In general, I believe PAMED would agree. I've seen this type of advice through other projects including health care reform. Also, open communications between a patient and their doctor is the foundation of good health care. These are all good areas for both the patient and doctor to chat about."
Consumer Reports announced 11 consumer-oriented organizations are helping to disseminate the Choosing Wisely information. Each of these organizations has the potential to reach at least 1 million consumers.
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."
A study in a 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 cost of the unnecessary tests is estimated at $200 billion to $250 billion each year in the United States.
Organizers of Choosing Wisely say the goal is not cutting costs, strictly speaking, but achieving the best value and the best care. If a test is necessary, it should be done. The campaign is not about rationing or withholding proper care, Cassel said. On the contrary; if waste is not reduced, there will be less money for care that is necessary.
"If we don't as a community collectively address this cost issue, then there's a whole lot of people that aren't going to get the care they need," she said.
Each of the nine medical groups contributed a top-five list of tests or procedures they determine are often unnecessary in their own fields, for a total of 45. They represent specialties that include family medicine, cardiology and oncology. The nine groups represent 374,000 physicians. The complete lists are available at www.ChoosingWisely.org. Additional medical specialty societies are to release lists in the fall.