A routine visit to the doctor's office can bring up a laundry list of medical tests, all designed to screen for one serious disease or another. But according to a new report from leading physician groups, a large number of medical tests and procedures billed as routine are largely unnecessary.
For many patients and doctors, it's easy to adopt the notion that if a little screening is good, more of it is better, "just to be sure" nothing is wrong. But that approach is costly, both in terms of health care dollars spent and the potential risks of the screenings.
"There's no medical treatment or test that is 100 percent without risk," said Dr. Christine Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation. "Things that you might think are routine actually should not be done because they expose patients to risk."
To help patients parse through the barrage of medical procedures, the ABIM Foundation and Consumer Reports have created the Choosing Wisely project, a campaign that asked nine physician groups to identify five tests or procedures in their fields that are overused or unnecessary.
Cassel said the project is designed to give patients as much information as doctors have about screening, as well as to rein in health care costs.
The full list is published today, but here's a look at five common tests you may not need.
ABC News' Dr. Amar Narula contributed to this report.
|Cardiac Stress Test|
Cardiac stress tests were once considered a staple of routine check-ups. Also called the treadmill test or an exercise EKG, doctors often use it to determine if a patient has blocked arteries.
The U.S. Preventive Services Task Force has long recommended that people at low risk for cardiovascular disease and with no symptoms of heart trouble don't need an annual stress test. But a 2010 Consumer Reports survey of 8,000 people ages 40 to 60 found that 44 percent of low-risk people with no symptoms had been screened.
"In the late 1990s, the concept of the executive physical became popular - this included a stress test and battery of labs and other tests that would be repeated annually no matter what the previous year's results, and everyone wanted to be considered as good as an executive," said Dr. Carolyn Eaton, a family physician in San Antonio. "I often will explain to middle aged patients that no, they don't need a stress test."
A basic exercise EKG costs about $200. Some doctors use a nuclear stress test in which a radioactive dye illuminates how well the heart is working. Those tests are priced at an average of $630.
According to the American College of Cardiology, stress tests should only be performed on patients who have peripheral artery disease, diabetics over age 40 and people who have an increased risk of coronary artery disease.
|Chest X-rays before Minor Surgery|
For many years, chest x-rays were another nuts-and-bolts part of hospital care.
"It was just what you did. You came to the hospital and got a chest x-ray," said Dr. Paul Larson, a spokesman for the American College of Radiology.
But the test is going by the wayside. The American College of Radiology said for most patients undergoing outpatient procedures, the tests are unnecessary.
Some people should get a chest x-ray before going under the knife, such as those with a history of heart problems, lung disease or cancer. For others with a normal physical exam, the ACR said the test leads to a change in patient care in only 2 percent of cases.
A standard chest x-ray costs about $44, fairly cheap compared with other medical price tags.
"But as we're trying to control health care costs in general, it's an example of things that aren't really necessary," Larson said.
|Imaging Tests for Lower Back Pain|
According to the American Academy of Family Physicians, lower back pain is the fifth most common reason for all visits to the doctor's office.
But unless a patient has certain red flags of a deeper physical problem, such as spinal abnormalities or neurological problems, the AAFP and the American College of Physicians say doctors shouldn't use MRIs, CT scans or other imaging to investigate lower back pain.
Dr. Lee Green, a professor of family medicine at the University of Michigan, said that can be a tough answer to a patient dealing with pain that can last for an average of three to six weeks.
"After two weeks, people are pretty sick of it, and they want something done about it," Green said. "To say the alternative is not to do anything is psychologically a very unsatisfying answer."
The alternatives may also be unsatisfying for patients who are seeking a fast, easy solution. Green said a person's best bet for fighting lower back pain is usually to keep moving and wait for the problem to get better.
But there is no evidence that imaging helps doctors solve a patient's lower back problem. At an average cost of $815 for a spine MRI, doctors say all the tests do is increase health care costs.
|Frequent Colon Cancer Screenings|
Colonoscopies, perhaps the most unloved cancer screening, are a necessary aspect of health care after age 50. A recent study found that having precancerous growths spotted on colonoscopies removed cut the death rate from colon cancer by 53 percent. Most major medical groups recommend that people over 50 get a colonoscopy every 10 years.
However, the key is moderation. According to the American Gastroenterological Association, most adults who are at an average risk of colon cancer and who get a clean bill of health from a colonoscopy don't need another one for the next decade – good news for health care pocketbooks, since the test costs an average of $1,050.
Eaton said the recommendation will probably be welcome news to most patients.
"Most people don't want one colonoscopy, let alone another sooner than needed," Eaton said.
|Bone Density Scans|
Osteoporosis becomes a real risk for people, particularly women, with increasing age. The National Institutes of Health estimates that one in five women over age 50 has osteoporosis. But patients may want to ask their doctors how often they r need a bone density scan to screen for signs of the disease.
The American Academy of Family Physicians echoes the U.S. Preventive Services Task Force in recommending that only women over age 65 get a bone mineral density test, called dual-energy x-ray absorptiometry, or a DEXA scan. The AAFP also recommends the test for men age 70 and older, although the USPSTF said there is insufficient evidence to balance the risks and benefits of screening men for osteoporosis.
The test costs more than $100, and unless a woman under age 65 has additional risk factors, such as smoking, an eating disorder or previous broken bones, doctors say the scan is unnecessary.
"I see unnecessary testing done in the community again and again," Dr. Ranit Mishori, associate professor in the department of family medicine at Georgetown University School of Medicine in Washington, D.C., told ABC News. "For some reason many women are told that they need a 'baseline' at 50, which is compeltely unsupported by the evidence."
A study published in February found that low-risk women who have a healthy initial scan can wait up to 15 years for a repeat scan.