Choose Wisely: Do You Really Need to Order That Test? Part 2

As I discussed in my blog post on July 10th, the necessity of many routine medical tests along with the need for an annual physical are being called into question.  How do you keep up with current medical guidelines and learn which routine tests may not be necessary?  This year, the American Board of Internal Medicine Foundation launched a new program called Choose Wisely.  

Choose Wisely aimsto save money and help medical providers provide quality medical care.  The program identifies over utilized medical tests and treatments that may be unnecessary.  The Choose Wisely website provides lists of medical tests in question and recommendations published by physician organizations.  Here are some sample recommendations:

  • American Academy of Family Physicians:  Don't routinely prescribe antibiotics for mild-to-moderate sinusitis unless symptoms last for seven or more days.  Don't order annual EKG's or any other cardiac screening for low risk patients without symptoms. 
  • American College of Cardiology: Don't perform stress cardiac imaging in the initial evaluation of patients without cardiac symptoms unless high risk markers are present.
  • American College of Physicians: Don't obtain imaging studies in patients with non-specific low back pain.
  • American Gastroenterological Association: For pharmaceutical treatment of patients with GERD, long-term PPI therapy should be titrated to the lowest effective dose needed to achieve therapeutic goals.

Many of these recommendations are commonsense- why would you prescribe a higher dose of PPI than the patient actually needs?  Given the ever increasing rate of antibiotic resistance, we have already been pushed to withhold antibiotic therapy.  As Dr. Michael Kirsch discusses in his blog, MD Whistleblower, these suggestions are not revolutionary but at least they are a start.  Choose Wisely is helping to raise awareness of the need to decrease the cost of healthcare among physicians.  For patients, it arms them with the necessary information to be involved in their healthcare plan. 

Any thoughts?