Doctors are often criticized for prescribing unneeded tests and procedures that harm more than they help and add to medical costs that could otherwise be avoided. 12 medical tests and procedures now being questioned worldwide as unnecessary and potentially cause — sometimes harmful results to patients. Since a campaign was launched last year, more than 130 tests and procedures have been called into question by 25 medical specialty societies with more than 500,000 member doctors.
"Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better," said Dr. Christine Cassel, president of the ABIM Foundation. "Through these lists of tests and procedures, we hope to encourage conversations between physicians and patients about what care they truly need."
United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures. See the full list
12 MEDICAL TESTS TO AVOID
1. Avoid Inducing Labor or C-Section Before 39 Weeks
Delivery prior to 39 weeks is associated with increased risk of learning disabilities, respiratory problems and other potential risks. While sometimes induction prior to 39 weeks is medically necessary, the recommendation is clear that simply having a mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)
2. Avoid Routine Annual Pap Tests
In average-risk women, routine annual Pap tests (cervical cytology screenings) offer no advantage. (American College of Obstetricians and Gynecologists)
3. Avoid CT Scans To Evaluate Minor Head Injuries
Approximately 50 percent of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may escalate future cancer risk. CT technology exposes patients to approximately 100 times the radiation of a standard chest X-ray which itself increases the risk of cancer. The recommendation calls for clinical observation prior to making a decision about needing a CT. (American Academy of Pediatrics)
4. Avoid Stress Tests Using Echocardiographic Images
The recommendation states that there is very little information on the benefit of using stress echocardiography in asymptomatic individuals for the purposes of cardiovascular risk assessment, as a stand-alone test or in addition to conventional risk factors. (American Society of Echocardiography)
5. Avoid Prescribing Type 2 Diabetes Medication To Achieve Tight Glycemic Control
The recommendation states that there is no evidence that using medicine to tightly control blood sugar in older diabetics is beneficial. In fact, using medications to strictly achieve low blood sugar levels is associated with harms, including higher mortality rates. (American Geriatrics Society)
6. Avoid EEGs (electroencephalography) on Patients With Recurrent Headaches.
Recurrent headache is the most common pain problem, affecting up to 20 percent of people. The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs. (American Academy of Neurology)
7. Avoid Routinely Treating Acid Reflux
Anti-reflux therapy, which is commonly prescribed in adults, has no demonstrated effect in reducing the symptoms of gastroesophageal reflux disease (GERD) in infants, and there is emerging evidence that it may in fact be harmful in certain situations. (Society of Hospital Medicine)
ADDITIONAL MEDICAL TESTS TO BE AVOIDED
8. Avoid Lipid Profile Tests
Lipid Profile test checks various parameters of blood, such as cholesterol (good or high density lipoprotein as well as bad or low density lipoprotein) and triglyceride levels. Several scientific papers have proven that people with high so-called "bad" LDL cholesterol live the longest and there is noow a large number of findings that contradict the lipid hypothesis that cholesterol has to be lowered at all.
9. Avoid Mammograms
Mammograms and breast screening have had no impact on breast cancer deaths and have actually been found to increase breast cancer mortality. With toxic radiation, mammogram testing compresses sensitive breast tissue causing pain and possible tissue damage. To make matters worse, the false negative and false positive rates of mammography are a troubling 30% and 89% respectively. Another concern is that many breast cancers occur below the armpits; however, mammography completely misses this auxiliary region, viewing only the breast tissue compressed between two plates of glass. Considering these drawbacks, breast thermography should be given closer consideration. Thermography is a non-invasive and non-toxic technique which can detect abnormalities before the onset of a malignancy, and as early as ten years before being recognized by mammography. This makes it much safer and potentially life-saving health test for women who are unknowingly developing abnormalities, as it can take several years for a cancerous tumor to develop and be detected by a mammogram.
10. Avoid PSA Testing
A PSA blood test looks for prostate-specific antigen, a protein produced by the prostate gland. High levels are supposedly associated with prostate cancer. The problem is that the association isn't always correct, and when it is, the prostate cancer isn't necessarily deadly. Nearly 20 percent of men will be diagnosed with prostate cancer, which sounds scary, but only about 3 percent of all men die from it. The PSA test usually leads to overdiagnosis — biopsies and treatment in which the side effects are impotence and incontinence. Moreover, there is some evidence which suggests that biopsies and treatment actually aggravate prostate cancer. During a needle biopsy, a tumor may need to be punctured several times to retrieve an amount of tissue that's adequate enough to be screened. It is believed that this repeated penetration may spread cancer cells into the track formed by the needle, or by spilling cancerous cells directly into the bloodstream or lympathic system.
11. Avoid Routine Colorectal Cancer Screening
Colorectal cancer screening often results in unnecessary removal of benign polyps which are of no threat to patients and the risks of their treatment or removal far exceed any benefit. The evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.
12. Avoid DEXA
Dual energy X-ray absorptiometry (DEXA or DXA) in a technique developed in the 1980s that measures, among many things, bone mineral density. The scans can determine bone strength and signs of osteopenia, a possible precursor to osteoporosis. Limitations abound, though. Measurements vary from scan to scan of the same person, as well as from machine to machine. DEXA doesn't capture the collagen-to-mineral ratio, which is more predictive of bone strength than just mineral density. And higher bone mineral density doesn't necessarily mean stronger bones, for someone with more bone mass will have more minerals but could have weaker bones.
Meanwhile, the ABIM effort is gaining momentum and more financial support from key players. The Robert Wood Johnson Foundationannounced it has awarded $2.5 million to "fund medical specialty societies and regional health improvement collaboratives to work in specific communities to raise awareness of potential overuse of medical care."
"Reducing the overuse of health care resources is a critical part of improving quality of health care in America," said Dr. Risa Lavizzo-Mourey, the Robert Wood Johnson Foundation's president and chief executive officer. "We want to see what can happen when this work is targeted in specific geographic regions and are pleased to help increase the tangible impact of the Choosing Wisely campaign.
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