Your back goes out, so your doctor sends you out for an MRI.
You see the neurologist about migraines, and you get a CT scan to rule out something sinister.
You’re taking medicine for high blood pressure, but now your arthritis is kicking up, so your doctor gives you a new prescription for a painkiller.
What do these scenarios have in common? They’re usually unnecessary tests or treatments. They mostly won’t help, but they can harm. A pioneering national campaign called Choosing Wisely, which brought together the nation’s medical societies to identify unnecessary tests and treatments, was supposed to help clinicians and patients reduce this epidemic of costly and unneeded care, which makes up nearly 30% of US health-care expenditures.
But it hasn’t.
Here’s what you need to know about seven common tests and treatments so you don’t get unnecessary care.
In a study published in JAMA internal Medicine, researchers at Anthem Inc. in Indianapolis and HealthCore Inc. in Wilmington analyzed billing data of approximately 25 million patients between 2010 and 2013—both before and after Choosing Wisely’s first set of recommendations came out in 2012. They focused on seven common tests and treatments.
Results: Only two of the seven actually showed significant (if modest) declines—imaging for headaches and cardiac imaging in patients with a low risk for heart disease. In contrast, the use of antibiotics to treat acute sinus infections remained high, as did the use of preoperative chest X-rays and imaging tests for low back pain. Two treatments—the use of prescription pain relievers in those with cardiovascular conditions and certain other conditions and HPV screening in women under 30—actually increased.
Here’s why it matters: Unnecessary tests and treatments are not only costly but often come with risk to patients—exposure to radiation or the chance of a “false-positive” that then leads to more unnecessary tests and even invasive treatments. Overuse of antibiotics, for example, often causes side effects such as stomach problems—and contributes to antibiotic resistance, which affects us all. The chart below details why these tests and procedures often aren’t needed—and what is still happening in doctors’ offices.
CAN WE START CHOOSING WISELY?
Simply educating physicians about these needless tests and treatments is not enough to halt their use. That’s what this study shows. In an accompanying editorial, experts from the University of California, San Francisco suggested that the health-care system needs more intensive physician education and better incentives for physicians who do comply with best practices.
Patients need to be part of the solution, too. You can start by not demanding a treatment such as antibiotics for acute sinusitis (instead, use what really works to clear your sinuses). Indeed, any time you’re given a medication, ask if it’s necessary and what risks there are to taking it.
Don’t push your doctor for extra tests, either—and be prepared to ask questions when a test is recommended. Ask questions such as “what is this test for?” and “how will the outcome of the test change my treatment?”
It may seem harmless, even prudent, when your doctor orders an extra scan to “rule out” a possible issue with your headache or back pain—or gives you a prescription. But in these seven situations, it’s not. As this study shows, we can’t rely on doctors to change the practice of medicine—we patients need to be vigilant, too. To learn more, see Bottom Line’s Medical Tests That Can Cause More Harm Than Good and The Epidemic of Overdiagnosis: Unnecessary Tests, Drugs and Surgery. Watch Out!.