Physician Groups Add 90 Overused Medical Tests, Procedures to Watch List

By Christina Orlovsky Page, contributor

March 6, 2013 - When it comes to commonly ordered medical tests and procedures, the power is often in the physician’s hand, with patients accepting their doctor’s word that such intervention is appropriate, and even necessary. According to a host of medical societies, however, routine is not always the best route of action.

To date, 25 physician groups have collaborated to release lists of more than 130 medical tests or procedures that are commonly ordered but potentially unnecessary--and possibly harmful. These lists are part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation, which works to advance medical professionalism and improve healthcare. Each participating society has identified five specific tests or procedures that are commonly performed in their profession, but whose use should be questioned.

Nine medical societies released their lists in April 2012; this February, one released a second list and 16 more physician groups released new lists, aimed at sparking conversations between patients and their physicians and helping both parties choose wisely about how to move forward with their healthcare.

The societies represent a broad range of medical specialties, from pediatrics to geriatrics to hospice and palliative medicine, and from neurology to urology to obstetrics and gynecology. The tests and procedures they warn against range from the use of feeding tubes in dementia patients to the use of CT scans in children with minor head injuries, and from imaging tests for a variety of complaints to treatments for minor conditions.

“The items on the lists were created by medical specialty societies representing more than 725,000 physicians. Twenty-five have now created lists and more will announce lists later this year,” said Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation. “We’ve heard that these lists are being received positively. Physicians understand that patients look to them to begin these conversations about what care is needed and what is not. These physician societies have accepted that leadership role. They are working closely with their memberships to ensure that conversations with patients take place.” 

These evidence-based lists were created with specific criteria in mind: each item needed to be within the specialty’s purview and control and each procedure needed to be done frequently and/or carry a significant cost. Publicly available documentation also needed to be available.

Since the launch of the multi-year campaign intended to “help physicians be better stewards of finite healthcare resources” and practice the less-is-more approach, Wolfson said the ABIM Foundation has seen a change in the approach that physicians take with their patients.

“We are not quantifying the amount of care delivered. We did not do pre- and post-utilization analyses of these tests or procedures. What we are doing is encouraging patients and providers to discuss if the test or procedure is needed, and we’ve seen a lot of momentum for that,” he said. “I’d encourage others to consider utilization analyses. That would be interesting and useful.”

Wolfson added that the initiative is achieving its goals of raising awareness among both medical professionals and the general public.

“We are exceeding our goals for the campaign--to spark and sustain a dialogue around issues of unnecessary care and overuse, both on a national level and in individual practices,” he continued. The campaign has been widely covered in consumer media, academic journals and at physician meetings; additionally, more than 80 million healthcare consumers have received patient-friendly information through Consumer Reports and the Choosing Wisely partners.

Among the influential partners backing the campaign is the Robert Wood Johnson Foundation (RWJF), which recently provided $2.5 million in grant funding to spread the Choosing Wisely message. According to Susan Mende, senior program officer with RWJF, the campaign fits perfectly with the goals of the foundation.

“The Robert Wood Johnson Foundation is committed to improving health and healthcare for all Americans. This includes ensuring that people get all the care they need, but also reducing care that is not needed,” Mende said.

“We know that more healthcare is not always better care. In fact, too much care can harm people by subjecting them to unnecessary dangers and treatments,” she continued. “Efforts like Choosing Wisely, which is focused on educating the public and promoting conversations between people and their health care providers about unnecessary tests and procedures, are critical to achieving better care.”

Mende concluded that the campaign is not only important to patients and providers, but also has meaningful implications for healthcare leaders who can drive change in the delivery of care.

“Healthcare leaders and providers can use the work of Choosing Wisely to support physicians and other providers in making patient-specific decisions based on evidence,” she said, “To examine the care they are providing to ensure that it is necessary, safe and tailored to individual patients’ needs.”

For more information or to download a specialty organization’s “Five Things Physicians and Patients Should Question” list, visit the Choosing Wiselyweb site.


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