From the Summer 2013 Issue of Newsletter
Last summer we let you know about tests and procedures that a group of medical specialty groups had identified as unnecessary and often harmful. Choosing Wisely®, an initiative of the American Board of Internal Medicine (ABIM) Foundation, together with more than 20 professional medical societies, has added 18 more tests and procedures to this list in an effort to spark conversations between patients and physicians about what care is really necessary. Some of the new recommendations include:
- Non-medically indicated inductions of labor or cesarean deliveries before 39 weeks of pregnancy should not be scheduled. Delivery prior to this time is associated with increased risk of learning disabilities and respiratory problems for the baby and postpartum depression for the mother.
- Feeding tubes in patients with advanced dementia should not be used. Assistance with oral feeding is a better, evidence-based approach.
- Routine annual pap tests are not necessary in women ages 30-65. Screening at three-year intervals is just as advantageous.
- Children with minor head injuries shouldn’t automatically have a CT scan. Clinical observation prior to making a decision about needing a CT will help reduce exposure to unnecessary radiation that may escalate future cancer risk.
- Stress tests on persons with no symptoms and a low risk of having coronary disease should be avoided. There is little information on the benefit of these tests in asymptomatic individuals.
- People with recurrent headaches should not have an EEG (electroencephalography). EEG has no advantage over clinical evaluation in headache diagnostics, does not improve outcomes, and increases costs.
- Infants with acid reflux should not routinely be treated with acid suppression therapy. Anti-reflux therapy has no demonstrated effect in reducing symptoms of gastro esophageal reflux in infants and may be harmful in certain circumstances.
Each specialty society involved in the Choosing Wisely® campaign, including the American Academy of Family Physicians, American Geriatrics Society, American Academy of Neurology, and American College of Rheumatology, identified at least five tests or treatments common to their profession, but not always beneficial. These recommendations encompass the most current evidence-based research within their specialty, and help make a positive impact on patient care, safety and quality. In addition to sharing these recommendations with their member physicians, the society aims to educate patients through member organizations, including the GIC.
Consumer Reports has published this research in easy-to-understand brochures and videos; see the February 2013, April and June 2012 issues of their magazine and their website (www.consumerreports.org) for more information. Consumer Reports recommends that patients ask their doctors the following questions if their doctor recommends one of the Choosing Wisely® tests and procedures:
- Do I really need this test or procedure?
- What are the downsides?
- Are there simpler and safer options?
- What happens if I do nothing?
- How much does it cost?
For a complete list of unnecessary tests and procedures, visit the Choosing Wisely website.
This information provided by the Group Insurance Commission.