“Millions of Americans are increasingly realizing that when it comes
to health care, more is not necessarily better,” said Dr. Christine
Cassel, president of the ABIM Foundation. “Through these lists of
tests and procedures, we hope to encourage conversations between
physicians and patients about what care they truly need.”
United States specialty societies representing more than 500,000
physicians developed lists of Five Things Physicians and Patients
Should Question in recognition of the importance of physician
and patient conversations to improve care and eliminate unnecessary
tests and procedures. See the full list
12
MEDICAL TESTS TO AVOID
1. Avoid
Inducing Labor or C-Section Before 39 Weeks
Delivery prior to 39 weeks is associated with increased risk of
learning disabilities, respiratory problems and other potential
risks. While sometimes induction prior to 39 weeks is medically
necessary, the recommendation is clear that simply having a mature
fetal lung test, in the absence of appropriate clinical criteria, is
not an indication for delivery. (American College of
Obstetricians and Gynecologists; American Academy of Family
Physicians)
2. Avoid
Routine Annual Pap Tests
In
average-risk women, routine annual Pap tests (cervical cytology
screenings) offer no advantage. (American College
of Obstetricians and Gynecologists)
3. Avoid
CT Scans To Evaluate Minor Head Injuries
Approximately 50 percent of children who visit hospital emergency
departments with head injuries are given a CT scan. CT scanning is
associated with radiation exposure that may escalate future cancer
risk. CT technology exposes patients to approximately 100 times the
radiation of a standard chest X-ray which itself increases the risk
of cancer. The recommendation calls for clinical observation prior
to making a decision about needing a CT. (American Academy of
Pediatrics)
4. Avoid
Stress Tests Using Echocardiographic Images
The
recommendation states that there is very little information on the
benefit of using stress echocardiography in asymptomatic individuals
for the purposes of cardiovascular risk assessment, as a stand-alone
test or in addition to conventional risk factors. (American
Society of Echocardiography)
5. Avoid
Prescribing Type 2 Diabetes Medication To Achieve Tight Glycemic Control
The recommendation states that there is no evidence that using
medicine to tightly control blood sugar in older diabetics is
beneficial. In fact, using medications to strictly achieve low blood
sugar levels is associated with harms, including higher mortality
rates. (American Geriatrics Society)
6. Avoid EEGs (electroencephalography) on Patients With Recurrent
Headaches.
Recurrent headache is the most common pain problem, affecting up to
20 percent of people. The recommendation states that EEG has no
advantage over clinical evaluation in diagnosing headache, does not
improve outcomes, and increases costs. (American
Academy of Neurology)
7. Avoid Routinely Treating Acid Reflux
Anti-reflux therapy, which is commonly prescribed in adults, has no
demonstrated effect in reducing the symptoms of gastroesophageal
reflux disease (GERD) in infants, and there is emerging evidence
that it may in fact be harmful in certain situations. (Society
of Hospital Medicine)
ADDITIONAL MEDICAL TESTS TO BE AVOIDED
8. Avoid
Lipid Profile Tests
Lipid Profile test checks various parameters of blood, such as
cholesterol (good or high density lipoprotein as well as bad or low
density lipoprotein) and triglyceride levels. Several scientific
papers have proven that people with high so-called “bad” LDL
cholesterol live the longest and there is noow a large number of
findings that contradict the lipid hypothesis that cholesterol has
to be lowered at all.
9. Avoid
Mammograms
Mammograms and breast screening have had no impact on breast cancer
deaths and have actually been found to increase breast cancer
mortality. With toxic radiation, mammogram testing compresses
sensitive breast tissue causing pain and possible tissue damage. To
make matters worse, the false negative and false positive rates of
mammography are a troubling 30% and 89% respectively. Another
concern is that many breast cancers occur below the armpits;
however, mammography completely misses this auxiliary region,
viewing only the breast tissue compressed between two plates of
glass. Considering these drawbacks, breast thermography should be
given closer consideration. Thermography is a non-invasive and
non-toxic technique which can detect abnormalities before the onset
of a malignancy, and as early as ten years before being recognized
by mammography. This makes it much safer and potentially life-saving
health test for women who are unknowingly developing abnormalities,
as it can take several years for a cancerous tumor to develop and be
detected by a mammogram.
10. Avoid
PSA Testing
A PSA
blood test looks for prostate-specific antigen, a protein produced
by the prostate gland. High levels are supposedly associated with
prostate cancer. The problem is that the association isn’t always
correct, and when it is, the prostate cancer isn’t necessarily
deadly. Nearly 20 percent of men will be diagnosed with prostate
cancer, which sounds scary, but only about 3 percent of all men die
from it. The PSA test usually leads to overdiagnosis — biopsies and
treatment in which the side effects are impotence and incontinence.
Moreover, there is some evidence which suggests that biopsies and
treatment actually aggravate prostate cancer. During a needle
biopsy, a tumor may need to be punctured several times to retrieve
an amount of tissue that’s adequate enough to be screened. It is
believed that this repeated penetration may spread cancer cells into
the track formed by the needle, or by spilling cancerous cells
directly into the bloodstream or lympathic system.
11. Avoid
Routine Colorectal Cancer Screening
Colorectal cancer screening often results in unnecessary removal of
benign polyps which are of no threat to patients and the risks of
their treatment or removal far exceed any benefit. The evidence is
insufficient to assess the benefits and harms of computed
tomographic colonography and fecal DNA testing as screening
modalities for colorectal cancer.
12. Avoid
DEXA
Dual
energy X-ray absorptiometry (DEXA or DXA) in a technique developed
in the 1980s that measures, among many things, bone mineral density.
The scans can determine bone strength and signs of osteopenia, a
possible precursor to osteoporosis. Limitations abound, though.
Measurements vary from scan to scan of the same person, as well as
from machine to machine. DEXA doesn’t capture the
collagen-to-mineral ratio, which is more predictive of bone strength
than just mineral density. And higher bone mineral density doesn’t
necessarily mean stronger bones, for someone with more bone mass
will have more minerals but could have weaker bones.
Meanwhile, the ABIM effort is gaining momentum and more financial
support from key players. The Robert Wood Johnson
Foundationannounced it has awarded $2.5 million to “fund medical
specialty societies and regional health improvement collaboratives
to work in specific communities to raise awareness of potential
overuse of medical care.”
“Reducing the overuse of health care resources is a critical part of
improving quality of health care in America,” said Dr. Risa
Lavizzo-Mourey, the Robert Wood Johnson Foundation’s president and
chief executive officer. “We want to see what can happen when this
work is targeted in specific geographic regions and are pleased to
help increase the tangible impact of the Choosing Wisely campaign.