Not every test and procedure is appropriate for a particular condition, says a coalition including 41 medical organizations. The campaign known as Choosing Wisely has updated its list of tests and procedures that patients and doctors should discuss thoroughly because they may not be necessary.
In April 2012, the Choosing Wisely campaign—launched by American Board of Internal Medicine (ABIM)—first began encouraging health practitioners and their patients to examine the usefulness of certain medical tests and procedures, with an eye to costs of health care and patient health. Initially, the campaign released 5 guidelines apiece from 9 medical specialties. They focused on common tests that are often administered without any obvious benefit to patient care.
More than 35 medical specialties have since joined the campaign. In February, 17 of them each released lists of 5 tests and procedures both doctors and patients should question. In all, these lists include 90 common, often unnecessary tests and procedures, including some many doctors might order for patients without symptoms. Consumer Reports Health and 14 other organizations including AARP and the National Partnership for Women and Families are disseminating the lists. Among the laboratory tests included in the lists are:
- Repetitive complete blood count (CBC) and chemistry testing in hospital patients with previous results that are stable; they may experience changes in hemoglobin and hematocrit levels from frequent blood draws that can contribute to anemia.
- Preoperative laboratory tests for healthy patients undergoing elective surgery
- Cervical cancer screening for women younger than 21 and those who have had total hysterectomies
- Human papilloma virus (HPV) tests for women younger than 30
- Vitamin D deficiency screening for low-risk patients
- Bleeding time tests, which have been replaced with other coagulation tests
- Immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests in the evaluation of allergies
- Testing for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate physical exam findings
- Surveillance testing with serum tumor markers for breast cancer patients who have been treated and have no symptoms
- Ovarian cancer screening with CA-125 in asymptomatic women at average risk
Along with their lists, the medical organizations each issued explanations of why they included particular tests and procedures. Lists are based on evidence from medical research, the coalition notes.
Greater efforts at educating doctors are underway. On March 21, the ABIM Foundation announced grants to 21 state medical societies, specialty societies, and regional health collaboratives. Organizations receiving the grants will educate doctors about the Choosing Wisely recommendations and help them build communication skills for conversations with patients about necessary care.
Though the lists provided by Choosing Wisely are based on what is considered evidence of best practices, they have been developed as guidelines intended to promote, not replace, patient-doctor dialogues. In talking with your health care practitioner, you can discuss what tests and procedures may be right for your situation. Whenever you have testing done, you can use resources like Lab Tests Online to help gain a better understanding of the tests ordered for you and their purpose, and to formulate questions to ask your health care practitioner when discussing the results.
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.
Choosing Wisely. Lists. Available online at http://www.choosingwisely.org/doctor-patient-lists/ through http://www.choosingwisely.org. Accessed March 26, 2013.
Press release. 21 Organizations to Engage Physicians and Patients in Conversations on Overuse of Medical Tests and Procedures. Choosing Wisely campaign. PDF available for download at http://www.choosingwisely.org/wp-content/uploads/2013/03/032013_ABIMF_RWJF-Grant-Press-Release_Final.pdf through http://www.choosingwisely.org. Issued March 21, 2013. Accessed March 26, 2013.
Medical Societies List 45 Dubious Tests, Therapies. Available online at http://www.medscape.com/viewarticle/761534 through http://www.medscape.com. Published April 4, 2012. Accessed March 26, 2013.
'Choosing Wisely' Targets 90 More Dubious Tests, Therapies. Available online at http://www.medscape.com/viewarticle/779700 through http://www.medscape.com. Published February 21, 2013. Accessed March 26, 2013.
AAFP Releases Second Choosing Wisely List of Tests, Procedures That Physicians, Patients Should Question. American Academy of Family Physicians. Available online at http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20130221choosingwisely2.html through http://www.aafp.org. Published February 21, 2013. Accessed March 26, 2013.