Archive for April 2012

Choosing Wisely- more tests are not always better

Choosing Wisely is a new campaign designed to help patients and physicians understand when certain tests need to be done and when they don’t. Nine different speciality societies (including the American Academy of Family Physicians) have been looking at evidence and providing resources published to the public through Consumer Reports. You can access these resources online at http://choosingwisely.org/?page_id=13.

The campaign has published lists of specific tests for medical problems that are often ordered but frequently are not needed. For example, one of the most common reasons I see patients in my office is for back pain. While back pain can be extremely painful, most often acute back pain resolves on it’s own in 6 weeks. However, many patients end up getting imaging tests done such as X-rays or MRI’s during that first 6 weeks. In our American medical culture, we often have the perception that more information will help you get better faster. But, that is not always the case. In fact, imaging of the back in patients within the first 6 weeks of back pain does not improve the outcome for the patient and often leads them to have procedures done which likely they did not need. In fact, I see many patients who have even more back pain after surgery which likely did not need to be done in the first place. Thus, the AAFP has recommended in their Choosing Wisely list to avoid imaging for patients with back pain within the first 6 weeks of the onset of their pain.

I agree with this recommendation. The problem is that many patients do not. And in an effort to satisfy the patient, doctors end up ordering the tests anyway. Also, in our litigious society, doctors are afraid if they wait to order the tests and it turns out a patient does need a further procedure, they will be sued for delaying the diagnosis (despite the fact that studies show it does not affect patient outcomes.)

These lists are an effort to encourage patients and doctors to discuss when tests are actually needed. And, I encourage my patients to recognize that more tests are not always the answer for your discomfort. Ordering more tests is a large part of the reason that America has the highest cost of medical care and the most unhealthy patients.