Ethics in Medicine

Doctor Panels Recommending Fewer Tests for Patients

Kristen Sparrow • April 06, 2012

As a follow up to yesterday’s post about patients opting for less treatment,  this article reports on the latest guidelines from 9 specialty boards, recommending fewer tests, and urging patients to refuse them if offered (!)  This blog may become obsolete! Ojala, as we would say in Spain.  Looking through the list, there seems to be an admission that sometimes even though the tests themselves may not be risky, the increased likelihood of false positives leading to more intervention is not a good thing.
Looking at the report what they did is ask each specialty to come up with 5 treatments or tests that should be given extra thought.  A quick read through reveals some of the following. 1) No antibiotics for simple rhinosinusitis  2) No imaging for low back pain less than 6 weeks duration  3) No pap smears for women under 21 years of age or post hysterectomy  4) Cardiac stress tests should be needed not routine  5) No CT nor MRI for simple sycope  nor for headache  6) For GERD,use the lowest dose of Proton Pump Inhibitors possible 7) Less imaging for early stage breast and prostate cancer 8) Avoid nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or Chronic Kidney Disease of all causes, including diabetes. (did not know this!!) (9) Avoid Cardiac Imaging (nuclear and CT) in low risk patients


Doctor Panels Recommend Fewer Tests for Patients
In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.
The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.
“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”