Docs Say Extra Tests Not the Key to Best Patient Care

April 4, 2012— -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.

The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.

Click here to learn about five common medical tests you may not need.

The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.

"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital. "Doing tests is not the same as providing care in all instances."

Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many. Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.

Several said patients who report non-specific headaches, fainting or lower back pain shouldn't be screened with x-rays, MRIs or other imaging.

In some cases, the recommendations related to routine prescriptions. Two groups advised against giving antibiotics for mild sinusitis.

Some of the recommendations are not radically different from what other groups have been saying for years. Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.

But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.

"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine. "And it should be just the beginning of a movement."

Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say. Often the reason is simple; a given test or procedure is what the doctor has always done.

Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger. Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.

"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.

But experts say it's time to drop this just-in-case mindset.

Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.

But many doctors say the real benefits aren't about saving health care dollars.

"This is not about controlling costs. This is about doing the right thing for patients in terms of medical testing," said Dr. Jay Siwek, professor of family medicine at Georgetown University School of Medicine.

Though tests are ostensibly performed to protect patients, most procedures come with some sort of risk, both from the procedure itself and from the steps doctors must take to follow up on a positive test result.

"If you order 20 blood tests on a patient, by chance alone, one will be abnormal. This leads to more testing to determine whether the abnormal test meant anything," said Dr. Richard Besser, ABC News' chief health and medical editor.

But fewer tests will likely lead to patient frustration.

"Patients expect tests; when we try to reassure patients without testing, they feel cheated or inadequately evaluated," said Dr. Patrick Lyden, chair of neurology at Cedars-Sinai Medical Center in Los Angeles.

The risk is that some patients to go from doctor to doctor until they find one willing to perform the procedure or test they want.

Dr. Christine Cassel, president and chief executive officer of the ABIM Foundation, one of the organizations behind the Choosing Wisely campaign, said the point of the project is to educate patients about excessive testing and the importance of avoiding it.

"Patients can inform themselves. They can ask their doctor, do I really need this?" Cassel said. "Most physicians are going to be very pleased to hear that coming from their patients."

The ABIM Foundation and Consumer Reports are already planning a second phase of the project. They have invited eight additional specialty groups to make recommendations, which could be released as early as the fall of this year.