Sources: Choosing Wisely.org (An Initiative of the American Board of Internal Medicine Foundation) Press Release; NY Times Health Blog
Under the “educational initiative” of Choosing Wisely, led by the American Board of Internal Medicine Foundation and involving 8 other specialty boards are recommending less routine testing for their patients. The thought process is that unnecessary testing is costly to the health care system and may actually harm patients. The move comes, not surprisingly, as insurance companies and third party payors (The US Government) are looking to shift costs back to hospitals and physicians. If there is any doubt as to the financial focus, the initiative is openly partnering with Consumer Reports on the initiative. The lists are presented as a series of questions (which will likely follow as practice recommendations) that patients and their physicians should question with suggested answers, including:
Q. Do patients need brain imaging scans (CT or MRI) after fainting, also known as simple syncope? A. Probably not. Research has shown that, with no evidence of seizure or other neurologic symptoms during an exam, patient outcomes are not improved with brain imaging studies. (American College of Physicians)
Q. Do patients need stress imaging tests for annual checkups? A. Not if you are an otherwise healthy adult without cardiac symptoms. These tests rarely result in any meaningful change in patient management. (American College of Cardiology)
Q. Should patients going into outpatient surgery receive a chest x-ray beforehand? A. If the patient has an unremarkable history and physical exam, then no. Most of the time these images will not result in a change in management and has not been shown to improve patient outcomes. (American College of Radiology)
Q. Do patients need a CT scan or antibiotics for chronic sinusitis? A. Most acute rhinosinusitis resolves without treatment in two weeks and when uncomplicated is generally diagnosed clinically and does not require a sinus CT scan or other imaging. (American Academy of Allegry, Asthma & Immunology)
Q. Should dialysis patients who have limited life expectancies and no signs or symptoms of cancer get routine cancer screening tests? A. These tests do not improve survival in dialysis patients with limited life expectancies, and can cause false positives which might lead to harm, over treatment and unnecessary stress. (American Society of Nephrology)
The Organizations, representing some 375,000 physicians, who released lists of questions with Choosing Wisely are: The American Academy of Allergy, Asthma & Immunology; The American Academy of Family Physicians; The American College of Cardiology; The American College of Physicians; The American College of Radiology; The American Gastroenterological Association; The American Society of Clinical Oncology; The American Society of Nephrology; and The American Society of Nuclear Cardiology.
From the press Release: “Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed,” said Christine K. Cassel, M.D., president and CEO of the ABIM Foundation. “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 released today kick off important conversations between patients and their physicians to help them choose wisely about their health care.” Consumer Reports (CR) – the world’s largest independent product-testing organization – is working with the ABIM Foundation and the specialty societies to lead the effort.”
Even specialists such as oncologists (cancer doctors) are being urged to cut back on scans for patients with early stage breast and prostate cancers that are not likely to spread rapidly. Patient advocacy groups and other specialists have expressed caution, warning that the directives could be misinterpreted and applied too broadly at the expense of patients.
If you or a loved one have been harmed by poor medical care, contact the Lewis Law Firm for a free consultation and opinion. The Lewis Law Firm is dedicated to improving the quality of health care delivery in Pennsylvania and New Jersey.
Posted by: Gayle R. Lewis, Esquire