Paging all doctors: A new set of guidelines, devised by a team of nine specialists plucked from eight separate medical specialty boards, recommends that physicians less frequently perform certain common procedures and prescribe some expensive medicines less often; it also advises patients to question the necessity of some of the tests they are offered.
Called Choosing Wisely, the latest initiative aims to rein in excessive health care costs by advising doctors against a list of common practices thought to be subject to over-use, such as EKGs during a routine annual physical exam, MRIs to diagnose back pain, and prescribing antibiotics for mild sinus infections.
Meanwhile, cardiologists are also being told to avoid routine cardiac imaging in asymptomatic patients, while oncologists are advised to hold back on scanning patients with breast and prostate cancers that are not likely to spread. As if that s easy to do, says ACSH s Dr. Gilbert Ross, who is skeptical about the guidelines. How does a practitioner know that without evaluation? The answer is not part of this advisory and in fact, few cases are amenable to such simplistic prospective analyses.
Some experts seem to believe that financial incentives for doctors are the real reason behind the increase in testing and the runaway costs of health care, but Dr. Ross counters that even when there s no financial benefit, doctors still often run extra tests because they want the best care for their patients. Also, he says, patients often demand particular tests, and these requests are often difficult to ignore.
Critics of the initiative which was crafted by the American Board of Internal Medicine in partnership with Consumer Reports say limiting a doctor s ability to perform certain procedures is akin to health care rationing. As Dr. Eric Topol, chief academic officer of Scripps Health, points out, This kind of one-size-fits-all approach can be a real detriment to good care.
While the hope is that physicians are ordering these tests to address real medical concerns, the reality is that many tests are adiministered out of fear of malpractice lawsuits. Though the Choosing Wisely program aims to provide doctors with extra protection from frivolous litigation through adherence to evidence-based guidelines, Dr. Ross is concerned that such stringent criteria as the ones proposed will result in cookie-cutter medicine. He adds, Unfortunately, it s a conundrum with no easy solution in sight, but to blame financial incentives as the culprit here is overly simplistic.