American medical societies are getting serious about lowering healthcare costs. Nine professional societies have recently issued lists of five dubious tests and therapies that physicians and patients should question (45 in total). The effort is part of a campaign called “Choosing Wisely.”
For example, “A man sees a physician after a simple fainting spell—should he receive a brain scan when there is no evidence of seizures or other neurological signs and symptoms?”
The answer is no. Such services, which are not rooted in evidencebased medicine, contribute to the high cost of healthcare and sometimes harm a patient’s health, as in excessive radiation exposure in the course of diagnostic imaging (one head CT scan equals the radiation dose from 100 chest x-rays) or complications of a surgery (pain, infection, blood clot, etc.) after a false-positive test result.
The example of what not to do for a patient who fainted belongs to the list from the American College of Physicians. In patients with no suggestion of seizure and no report of other neurologic symptoms and signs, the likelihood of its being due to the central nervous system is extremely low, and patient outcomes are not improved with brain imaging studies.
Also on the questionable list:
• Annual screening cardiac stress tests (American College of Cardiology)—they don’t change treatment.
• Chest x-ray before surgery with normal history and physical (American College of Radiology)—patient results are not improved.
• CT scan or antibiotics for sinusitis (American Academy of Allergy, Asthma & Immunology)—gets better in two weeks on its own.
• Routine breast, cervical and colorectal cancer screening tests for dialysis patients with limited life expectancy (American Society of Nephrology)—they do not prolong life, and positive results lead to overtreatment and needless worry.
• Osteoporosis screening, or a DEXA scan, in women before age 65 and men before age 70 without special risk factors (American Academy of Family Physicians)—is not helpful for preventing bone fractures.
• Colorectal cancer screening after a high-quality negative colonoscopy without special family or personal risk factors (American Gastroenterology Association)—does not increase cancer detection or prolong life.
• PET, CT and bone scans for early prostate cancer or early breast cancer (American Society of Clinical Oncology)—does not improve detection of cancer spread or increase cancer survival, and leads to overtreatment, harm and needless worry.
• Cardiac stress test or coronary angiography in asymptomatic, low-risk patients (American Society of Nuclear Cardiology)— do not lead to better results and one coronary angiography delivers the same radiation dose as 1,000 chest x-rays.
These professional societies hope their lists kick off important conversations between patients and their physicians to help them choose wisely about their healthcare. To read the lists in full, or for more information, visit choosingwisely.org.iBi
