Less is better.
Doctors perform too many tests and procedures, and patients demand too many as well, a national report published Wednesday says.
The report, called Choosing Wisely, involved 45 tests, procedures and medications that generally should be questioned when patients ask for them or doctors call for them.
In some cases, a test not only wastes money but also leads to more scans and procedures that are costly and sometimes painful and unnecessary, said Dr. Thomas Tape, chief of general internal medicine at the University of Nebraska Medical Center.
"There's a misconception that more is always better," Tape said.
The report seeks to ratchet down runaway U.S. health care spending, some of which is directed toward scans, tests, doctor visits and treatments that don't help patients.
The report, compiled from the recommendations of nine American medical groups, represents ongoing efforts to evaluate therapies and tests so they are applied to patients who will benefit from them, said Dr. Mark Anderson, head of the University of Iowa College of Medicine's department of internal medicine.
"And when it's used indiscriminately, even a good test won't provide value," Anderson said.
The nine medical societies involved represent about 375,000 physicians.
Among the many items addressed and recommendations made:
» Do not order sinus CT scans or prescribe antibiotics for mild or simple rhinosinusitus, or sinus infection.
» Do not do scans for lower back pain within the first six weeks unless serious underlying conditions or signs exist.
» Do not order annual EKGs or other heart screens for low-risk patients without symptoms.
» Do not perform scans for uncomplicated headaches.
» Do not repeat colorectal cancer screening by any method for 10 years after a colonoscopy is negative in average-risk patients.
Dr. Donald Frey, vice president for health sciences at Creighton University, said medical technology has advanced rapidly. Doctors and patients assume it can be broadly applied, but that's not always the case.
Frey said a jackhammer is the more advanced tool, but a hammer is better for many jobs.
Knowing when not to use certain technology can be as important as knowing when to use it, Frey said.
The recommendations came from nine American medical groups and were funneled through Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation.
Dr. Robert Recker, director of Creighton University's Osteoporosis Research Center, said one recommendation could do more harm than good. The recommendation says DEXA, a form of X-ray screening for osteoporosis (a disease that makes bones brittle and weak) shouldn't be used for women younger than 65 or men under 70 with no risk factors.
Recker said he fears that doctors and patients will overlook the clause, "with no risk factors." Recker said the risk factors for osteoporosis are many and include smoking, chronic diseases involving the kidney, lungs, gut and other organs, inflammatory arthritis and more than brief treatment with cortisonelike drugs.
The United States faces an epidemic of fractures from osteoporosis, "and we need common sense involved" in testing for the disease, he said.
"The problem is how it's going to be interpreted," he said of the report.
Choosing Wisely said the Congressional Budget Office has estimated that up to 30 percent of care in the United States goes toward unnecessary tests, procedures, hospital stays and other services. If trends continue, American health care spending will reach $4.3 trillion and make up 19.3 percent of the nation's gross domestic product seven years from now, the report said.
The United States spends more than any other nation on health care and still ends up with disappointing results in the population as a whole.
UNMC's Tape said Choosing Wisely encourages doctors and patients to avoid over-ordering tests, diagnostic imaging and procedures. Tape said it could have a strong influence on how medicine is practiced. "That's our hope."
This report includes material from the Associated Press.
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