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Outside editorial: Better health, fewer tests

Posted: April 24, 2012 - 12:00am

The following editorial appeared in the Miami Herald:

When nine medical societies announce that at least five common practices in each of their specialties are unnecessary, wasteful or even harmful to patients, everyone should take note.

Everyone — patients, doctors, the health care industry, insurers and various levels of government. The point the societies are making is not that we should ration medicine but, rather, tailor the care to the individual patient’s particular health needs and medical and family history.

That would be a significant departure from simply ordering high-tech tests or prescribing certain medicines even when experience dictates they are not necessary, can be harmful and only add to the health care bill.

Yes, the mention of cutting costs in health care stirs an unlovely stew of suspicions, each supported by some semblance of fact: insurers protecting profit and high salaries, “defensive” medicine in this litigious age, hip-pocket needs of doctors, drug-company advertising promoting costly “cures” that aren’t, demanding patients, government interference in medical practice, and more.

The outrage over recent recommendations for fewer mammograms and Pap smears for many, but not all, women (again, depending on their individual history and medical protocols) was telling in its emotionality and in the ferocity of advocacy groups.

Yet, the fact remains: Americans spend much more on health than other countries without return for that extra investment. One estimate is that one-third of the $2 trillion spent annually on healthcare is wasted. Just half of that one-third estimate is a scandal.

So the conversation about finite resources and promise of better care with fewer procedures or medicines is too important to ignore as just one more report, one more recommendation.

Under the guidance of a foundation connected to the American Board of Internal Medicine, the nine societies representing 375,000 doctors in specialties and general medicine each chose five common practices that are widely used but contribute little to improved care. Eight more societies will release their top five wasteful practices in the fall. These lists are hardly inclusive of all wasted dollars.

The lists range from giving chest X-rays to all people having outpatient surgery and CT scans after a simple episode of fainting to routine cancer screening tests to dialysis patients who are expected to die soon. (See www.choosingwisely.org.)

What makes this effort noteworthy are twofold: The recommendations come from doctors, not government panels so unpopular in this age of backlash against government, and the doctors are joined by Consumer Reports and 11 consumer-oriented groups. Their participation is intended to promote awareness of overtreatment.

The societies are encouraging patients, doctors and other healthcare professionals to talk about the health risks of over-testing or taking certain drugs. For instance:

• When do you need an EKG or stress test for heart disease?

• When do you need an imaging test for a headache?

• When do you need antibiotics for sinusitis?

Changing doctors’ customary practice and patients’ expectations will be hard work with shared responsibility.

The participating medical societies and consumer groups would honor their own hard work on this initiative with regular updates on how well, or not, their guidelines are working.

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