You May Not Need That Test, But Will You Still Get It?

About a third of all the money we spend on health care goes to waste, according to many experts who look at why health care costs are out of control in the United States.  But what’s waste?

Well, some of it is that MRI for lower back pain. Or the prescription you filled for antibiotics even though you had a viral, not bacterial, sinus infection.

The arguments about when a test makes sense and when it doesn’t have been long and loud for years. A national campaign called Choosing Wisely aims to limit that debate by asking doctors to decide what’s not useful and what may, in some cases, harm patients. It launched last April with a list of 45 tests, procedures and medications that nine specialty groups say are often unnecessary. Today the campaign adds another 90 items.

Daniel Wolfson, Executive Vice President, ABIM Foundation

Daniel Wolfson, executive vice president, ABIM Foundation

“There’s incredible leadership being shown by the specialty societies in addressing appropriate care and waste, and a willingness to partner with consumers and patients to talk about these issues,” said Daniel Wolfson, executive vice president of the ABIM Foundation, the organization spearheading the Choosing Wisely campaign. “I think this is unprecedented.”

Leaders of the specialty groups may be motivated to participate, in part, by pressure to reduce money wasted in health care. Many of these recommendations will, if followed, lower costs. But campaign organizers say the focus is on avoiding harmful or unwarranted tests.

The expanded list includes:

  • No induced labor or C-sections before babies are full term (39 weeks) unless there’s a medical emergency
  • No annual pap tests for women age 30 to 65; every three years is fine
  • No feeding tubes for patients with advanced dementia
  • Limited CT scans for children with minor head injuries (the risk of cancer from radiation outweighs possible benefits of the test in most cases)

Individual doctors may not follow these recommendations out of habit because they disagree or because they are still paid based on how many tests or procedures they do. Wolfson acknowledges there’s no proof yet that doctors are changing the way they practice medicine since the campaign began last April.

“But what I see, going across the country, particularly in Massachusetts,” Wolfson said, “are people very focused on what is value and how can we achieve the most value and in those environments. I believe those recommendations will be implemented.”

And what about you, are you ready to ask your doctor, “Do I really need this test?” There’s a lot of money being spent trying to figure out how to get you to ask.

Dr. John Santa, who runs the health care ratings center at Consumer Reports, says research shows “consumers are much more likely to listen to messages about overuse and waste if it also causes, potentially, some harm.”

Dr. John Santa, Consumer Affairs

Dr. John Santa, Consumer Affairs

But harm is a nuanced concept in the world of health care quality. Take an electrocardiogram, or EKG, that test where someone tapes electrodes across your chest. You should have this test if you have heart problems. But if you don’t then getting that test during an annual physical should not be part of the routine.

“It’s not the test itself that’s harmful,” Santa said. “It’s the fact that the test can lead to confusion, to false positives, to other tests and even to treatment that ultimately can harm them.”

Doctors do recommend having your blood pressure and cholesterol checked yearly to make sure you’re not at risk for heart problems.  And of course, you should eat your fruits and vegetables, exercise, get plenty of sleep — you know the drill. If we were all doing these things, we wouldn’t need so many tests in the first place. Choosing Wisely plans to expand the list of potentially unnecessary tests, medications and procedures in September.

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  • Justin Locke

    When doctors are profiting from tests and procedures, it’s very much like paying the fire department by the fire.

  • Reasonable?

    Medicine is moving quickly from a cottage industry to a big box business.
    The Walmart of healthcare (whoever takes that position), will implement processes like one described above.

    Right now doctors learn this stuff at conferences are expected to memorize it and act on it. That’s a pretty antiquated model. On the other heand computers are pretty good at enforcing “best practices”.

  • Kristen Hanssen Goodell

    You didn’t mention a huge driver of unnecessary testing; which is patients’ expectations. Our style in the US tends to be one of intervention, so often patients truly believe they need a test or medication that isn’t indicated. Sometimes when I explain the rationale behind the treatment or test, and why I don’t think it’s necessary, people are satisfied, but many times patients will insist; stating that their insurance will pay for it, or it worked last time, etc. I think we need to educate the public as much as we do the doctors.

    • Martha Bebinger

      Yes – I absolutely agree (and there’s a mention in the radio version of the story)! What works and what doesn’t in your conversations about tests with patients?

  • Emily Barrett Antul

    Yes! Glad to hear they’re looking at interventions around labor and delivery! They need to keep looking! The evidence strongly shows that most of what they do in a standard L&D ward is not only unnecessary, but not medically indicated and potentially harmful to the point where the risks of many of their standard procedures far outweigh the benefits and only cause more interventions. We have one of the highest rates in the industrialized world of morbidity and mortality (illness and death) around labor and delivery of BOTH mother AND baby. We also intervene the most… coincidence? I think not.

    • Martha Bebinger

      Emily – what are the top three things done during a standard L and D that are unnecessary and potentially harmful?