Question doctors on tests, treatments, report advises

Some common procedures, such as stress test or imaging for back pain, unnecessary, costly.

Physicians and patients should question some commonly used tests and treatments that often are unnecessary and costly and may in some cases be harmful, says a report out today that’s part of a new campaign to improve care and cut waste.

Some of the recommendations have been around, but the campaign represents a rare coordinated effort among multiple medical societies.

Nine leading physician specialty societies — including the American Academy of Family Physicians, the American College of Cardiology and the American College of Physicians — each identified five procedures, treatments and tests (for a total of 45) that the groups say are routinely used but may not always be necessary. Their lists are being released today as part of the ABIM (American Board of Internal Medicine) Foundation’s Choosing Wisely campaign (choosingwisely.org), which is being done in conjunction with Consumer Reports magazine.

For instance, the American College of Radiology says people don’t need routine chest X-rays before surgery if the patient has an “unremarkable” medical history and physical exam.

One goal of the campaign is to make people “feel empowered to go to their doctor and say, ‘Do I really need this test?’ ” says Christine Cassel, president of the ABIM and the group’s foundation.

John Santa, an internist and the director of the Health Ratings Center for Consumer Reports, says, “I think it’s courageous of cardiologists, internists and family physicians to suggest reducing services that they know generate income for some of their members. I’m sure some of their members won’t be happy.”

Among the campaign’s advice to physicians and patients:

-Don’t do imaging for lower back pain within the first six weeks unless there are red flags, such as decreased strength in a leg, says the American Academy of Family Physicians. It does not improve outcomes but does increase costs.

-There’s no need to repeat colorectal cancer screening for 10 years if a high-quality colonoscopy comes back negative in average-risk indi- viduals, the American Gastroenterological Association says.

-Don’t routinely prescribe antibiotics for acute mild-to-moderate sinus infection unless symptoms last for seven or more days, the American Academy of Family Physicians says. Most sinusitis is due to a viral infection and will resolve on its own.

-Don’t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors, the family physicians group says.

-Don’t obtain a stress test or treadmill test for individuals who have no symptoms of heart troubles and are at low risk for coronary heart disease, the American College of Physicians says.