Testing, testing
CAMPAIGN WARNS overuse of tests such as CT scans offers little benefit
The nation’s doctors have compiled a list of questionable or worthless tests and procedures, in every specialty of medicine, that offer little benefit, and possible harm, including X-rays for lower back pain or CT scans for uncomplicated headaches.
The “Choosing Wisely Canada” campaign targets tests and interventions that are often a waste of money and don’t help patients recover sooner.
In addition to X-rays for simple back pain, the list warns against routine CT scans or MRIs for headaches. A CT scan of the head can deliver a radiation dose equivalent of up to 300 X-rays, while CT scans of the lower back can expose testicles and ovaries to substantial radiation. A CT scan for low back pain should only be done if “red flags” are present, including a history of cancer or unexplained weight loss.
The doctors are also calling for more judicious use of antipsychotics and sedatives, fewer whole-body scans, fewer red blood cell transfusions and limiting use of urinary catheters. Studies suggest urinary catheters are unnecessary in up to 50 per cent of cases.
Other procedures that doctors — and patients — should question are routine X-rays or ECGs for low-risk patients without symptoms of coronary artery disease. ECGs, or electrocardiograms, which record the heart’s electrical activity, can lead to “false positives” and needless and invasive follow-up procedures.
CT scans shouldn’t be ordered for uncomplicated headaches, except in cases where the headaches are becoming more frequent or severe, or the patient is experiencing dizziness, lack of co-ordination, tingling, numbness or other “red flags,” according to the experts.
Other examples of tests or drugs prescribed more often than necessary are yearly routine blood tests and antibiotics for sinusitis. Up to 20 per cent of all antibiotic pre- scriptions to adults are for sinus infections, even though the problem is almost always caused by a viral, and not bacterial, infection (antibiotics don’t work against viruses).
“Both doctors and patients have come to think of medicine as ‘more is better’ — we should get that and that and that,” said Dr. Wendy Levinson, chair of medicine at the University of Toronto and chair of the Choosing Wisely campaign. “This isn’t good quality care.”
“We will try to get this out to physicians. All of these recommendations are based on very rigorous scientific review by respected colleagues, so we hope that they will, over time, get embedded in practice.” The U.S. Institute of Medicine estimates that 30 per cent of what’s ordered could be viewed as “not adding value for patients,” Levinson said. Nine participating medical societies developed “Top 5 lists” of tests, treatments and procedures they say are done more often than necessary.
For more information, visit www.ChoosingWiselyCanada.org