Doctors all too often use medical tests that are almost entirely unnecessary – and that's according to the doctors themselves.
Nine leading physician specialty societies, representing nearly 374,000 physicians nationwide, each released a list on Wednesday morning enumerating a total of 45 common medical procedures that doctors should think twice about before ordering.
The effort is part of the Choosing Wisely campaign, which aims to help patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary.
Each of the nine specialty societies compiled a list of "Five Things Physicians and Patients Should Question," tallying up 45 questions total. The American College of Cardiology, for example, cautioned physicians not to perform stress cardiac imaging or advanced non-invasive cardiac imaging – both of which are expensive tests – as a pre-operative procedure for patients who are scheduled to undergo low-risk, non-cardiac surgery. (That's right – non-cardiac surgery.)
The American Gastroenterological Association said that, for average-risk individuals, physicians shouldn't repeat colonoscopies within 10 years of a high-quality colonoscopy procedure that came up negative for cancer. The American College of Physicians said that expensive imaging tests for patients with "non-specific low back pain" do not "improve patient outcomes."
And there's 42 more recommendations in the same vein. It's an illuminating glimpse of the money spent on unnecessary medical costs every year, which some experts estimate can be more than $666.5 billion.
Christine Cassel, president and CEO of the ABIM Foundation, an organization which works to improve health care by advancing medical professionalism and which is leading the Choosing Wisely campaign, applauded the specialty societies.
"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," Cassel said in a press release. "Physicians, working together with patients, can help ensure the right care is delivered at the right time for the patient."
In addition to reducing wasteful spending – which will be especially necessary come 2015 when hospitals' and doctors' pay will begin to be based on the quality of patients' care, not the number of services received – the initiative is also an effort to help patients get better, intentional care, rather than be barraged with medical tests.
"We know there is overuse and waste in the system, so let's have doctors take responsibility for that and look at things that are overused," Cassel told MSNBC. "We're doing this because we think we don't need to ration health care if we get rid of waste."
Nina Vaccaro, the executive director of the Southside Coalition for Community Health Clinics, which is based in South L.A., said it was a step in the right direction.
"I do think physicians really need to be more thoughtful and careful on how we use the limited resources that we have," she said. "We want to be able to provide health care coverage without draining the system, and that's a long-term problem. I would like to think that physicians are thinking about that."
Vaccaro said that physicians working in the "safety net" system – that is, physicians working with the uninsured and the underinsured demographic, which has a large presence in South Los Angeles – "are always careful about the tests they're running because their resources are limited, and those tests are expensive."
That may be difficult for some patients to deal with – James Fasules, a member of the American College of Cardiology, told MSNBC that tests don't necessary equal quality care.
"We kind of have a general feeling that if you don't get a test, you haven't been cared for well," he said. "That has permeated American culture now."
But Vaccaro said it's simply common sense.
"Generally speaking, I think it makes sense that we're only subjecting patients to testing and diagnostic studies that they truly need," she said. "I think any human being would truly want that."
There's also the issue of reducing costs. Vaccaro said that right now, the person who pays out of pocket for health insurance is the one ultimately getting hit the hardest by unnecessary spending.
"If we're able to reduce costs," she said, "the individual cost could go down and that could mean that more individuals could afford to buy health insurance." That could also mean more small business owners could afford to provide their employees with insurance.
Vaccaro, whose organization promotes the idea that health care is a basic human right, said decisions about unnecessary spending ultimately do impact the individual.
"I think overall, we're looking at how do we reduce the cost of care as a whole, and really just focus on what the patient actually needs," she said.
Others added a note of caution, emphasizing that truly being attentive to patients won't always mean less tests – and that sometimes it could mean more.
"These [list items] all sound reasonable, but don't forget that every person you're looking after is unique," said Eric Topol to MSNBC. Topol is the chief academic of Scripps Health, a health system based in San Diego. "This kind of one-size-fits-all approach can be a real detriment to good care."
In its press release, the ABIM Foundation said that eight more specialty societies had joined the Choosing Wisely campaign and would release their respective lists of five questions in the fall.
Photo by Paula Steele via Flickr Creative Commons.