A new national campaign to reduce inappropriate tests and procedures was launched in early April 2012 by nine medical specialty societies in association with Consumer Reports magazine. The campaign, called “Choosing Wisely,” is intended to educate the public and clinicians both about the need to do a better job in ordering appropriate tests and medications.
When you think about it, it is unprecedented in the history of American medicine for such a wide range of specialty societies to jointly encourage a more cost-effective approach to test ordering. So why did this happen, and why did it happen now? In large part it is because of the unavoidable reality that hundreds of billions of dollars (yes, that is billions with a b) is wasted each year on inappropriate and unnecessary tests and procedures. The cost of health care in the U.S. is obviously a major topic of national discussion these days. When so much money is spent on ineffective interventions, we physicians truly need to take responsibility for addressing the problem. Physicians, heal ourselves. If we don’t, we open the door for someone else to come in and decide they know how to heal us better than we do. And that would not likely be a pretty picture. For so many prestigious medical societies to jointly decide to take on this project reflects their awareness that the time has come for physicians to do a better job.
Each of the nine specialty societies listed five tests and procedures that are overused, according to scientific evidence. This generated a list of 45 items. The lists can be found at the campaign’s website, www.choosingwisely.org. Among the recommendations are the following:
- Don’t do imaging studies for low back pain for the first six weeks, if no red flags are present.
- Don’t prescribe antibiotics for mild-to-moderate sinusitis for the first seven days.
- Don’t order routine pre-op chest xrays unless there is suspicion for intra-thoracic disease.
- Do not repeat colorectal cancer screening for 10 years in average-risk individuals who have had a negative high-quality colonoscopy.
The recommendations got a fair amount of media attention for about two days after the report came out. But the lack of sustained publicity does not make the recommendations any less important. Our patients may be asking us what we think, so it is good to familiarize yourself with the recommendations by going to the website. The advice provided is high quality, scientifically sound, and can help each of us make a small dent in the health care cost problem.
Richard Fleming, MD