Choosing Wisely – Preventing Overprescribed and Unnecessary Testing

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The American Board of Internal Medicine (ABIM) launched a new initiative last week called “Choosing Wisely” that identifies medical interventions, i.e. radiology exams, procedures, surgeries, etc. that are often over prescribed and offer no real benefit to patients.

Nine societies in all, including the American College of Cardiology, the American College of Radiology and the American College of Gastroenterology, created lists of Five Things Physicians and Patients Should Question.

The American College of Radiology recommends “Don’t do imaging for uncomplicated headaches.” The American Academy of Family Physicians listed “Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.” Cardiologists weighed in with “Don’t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.”

This is not completely new territory. Back in 2002, the New England Journal of Medicine published a randomized controlled study of arthroscopic surgery for osteoarthritis of the knee. The participants in the study (180) received either a real arthroscopy or a sham arthroscopy. The study showed there was no difference in outcomes, the participants got better at the same rate.

Doctors are paid through a fee for service model that rewards doing – not educating or listening. They don’t get paid to spend time talking to you. They get paid by the number of scans they run, procedures they perform and surgeries they complete. The profit margin for performing an arthroscopy is very high, so doctors are incentivized to do them. Preventative services and patient education have very low profit margins which is why you get about 15 minutes with your doctor at an office visit.

Anyone who cares about reducing healthcare costs in this country needs to trumpet the recommendations from “Choose Wisely” and empower and educate patients to question the need for expensive tests and unnecessary procedures. This is how we slowly bend the cost curve so that our healthcare system is sustainable in the long term.

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