In 2017, John Hopkins University School of Medicine surveyed 2,106 doctors across the United States for their views on unnecessary medical care. The respondents estimated that about 20 percent of care provided to patients is unnecessary, including 24.9 percent of tests and 11.1 percent of procedures.
An international campaign spearheaded by the American Board of Internal Medicine called “Choosing Wisely” seeks to promote conversations between patients and their doctors so that they can choose care that is truly necessary, supported by evidence, free from harm and not duplicative of other tests or procedures already received.
As part of this initiative, more than 70 medical specialty societies have identified a series of medical tests, treatments and procedures that are commonly used in their field whose necessity should be questioned and discussed. These services contribute to wasteful health care spending as they often provide minimal medical benefit. In certain instances, they may even cause harm to the patient. For example:
Use of Antibiotics
- The Infectious Disease Society recommends against routinely using antibiotics for upper respiratory infections, as most are caused by viruses which antibiotics are ineffective against. When antibiotics are overprescribed, they become less effective in treating the bacteria. This has led to an increase in antibiotic resistance and superbug scares. According to the Center for Disease Control, at least 2 million Americans each year are infected with bacteria resistant to antibiotics and 23,000 of these patients die as a result.
Imaging for lower back pain
- According to the American Society of Anesthesiologists, imaging tests for lower back pain are frequently not useful and do not improve outcomes. Plus, many of these tests can be harmful since they use radiation and may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery. To help relieve pain, patients should try self-care steps first, such over-the-counter pain medicine or simple exercises and stretches, before they have a test.
How to avoid unnecessary care
Choosing Wisely starts with patients having a conversation with their doctor to make sure they end up with the right amount of care — not too much and not too little. Here are five key questions patients should ask their doctor before undergoing any test, treatment or procedure:
- Do I really need this? How well will this identify or treat my problem?
- What are the risks? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure? Will there be side effects?
- Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier food or exercising more.
- What happens if I don’t do anything? Always check to see if your condition might get worse – or better – if you don’t have the test or procedure right away.
- How much does it cost? Are there less expensive tests or treatments available to you? Make sure your insurance covers the service. For medications, see if a generic drug can be prescribed instead of brand-name drugs.
“Sometimes saying ‘no’ to medical care is good for you,” said Mike Merrill, MD, Medical Director, Clinical Performance Management, Independent Health. “For example, medical imaging tests can provide helpful information and are sometimes essential, but they can be misleading. They can show us incidental abnormalities that would never hurt you, but which lead to follow-up testing and procedures that don’t do you any good. And sometimes lab tests can show a problem when there isn’t really one there. These are called ‘false positives.’ To avoid these potential issues, it’s important that physicians and patients carefully consider the options together before going forward.”
To learn more about the tests, treatments and procedures that the Choosing Wisely campaign is focusing on, visit www.choosingwisely.org.