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Trisha Torrey

Unnecessary, Harmful and Now Public - 45 Procedures We Patients Do Not Need

By April 4, 2012

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My email, listserves, Twitter (and I understand the national news, too) were on fire with a surprise announcement that describes 45 medical tests, procedures and treatments we patients just don't need, but have been paying for - to the tune of $30 billion a year.

You read that right. We've been paying for them. We don't need them. Some of us have been harmed by them. And now we have the information we can use to say "no."

Now, ordinarily I would say, "Seriously? You think we patients are going to believe this? This must be one more of those announcements that some government group, or some consortium of insurers are telling us we don't need just so they can save themselves some money! Like I'm going to believe THAT?"

But not this time.

In fact, the people who put this list together are the very people who are the ones MAKING the money from these tests and procedures! It's an initiative pulled together by the Foundation of the American Board of Internal Medicine (ABIM) and Consumers Union. They reached out to medical specialty boards and asked them to compile the top 5 tests, procedures and treatments that should not be given to patients because they are a waste, or they are dangerous. Nine boards responded - thus 45 medical tests, procedures and treatments on that list, under the title "Choosing Wisely."

So we have to ask - what might their motives be? Why would they be willing to come forth to day "Hey! Don't pay my colleagues for these kinds of procedures because you're being ripped off - and you could get hurt!"

It's just a guess - but I think that answer would be - money.

As costs continue to go up and up, Medicare (followed quickly by private insurance) is decreasing its reimbursements to doctors for many of the things they do. I have to think that these primary care doctors and specialists may actually be interested in shifting the costs from stuff that doesn't work or help, to stuff that does. If they can get their colleagues to stop doing unnecessary things to patients - they stand to make more money from the procedures that are necessary.

I reviewed all those tests (and by the way - it's tough to find them all in one place - except that I've put them all in one place.) There are some generalizations we can make:

  • A few boards cited the same unnecessary kinds of things - like cutting back on imaging.
  • A few boards focused on reducing the amount of antibiotics prescribed to patients who don't really need them.
  • I was happy to see a few references to shared decision making between the professionals and the patients and families.

Take a look at the lists, broken out by specialties, with links to the boards that developed them.

Included are some steps to take if your doctor wants to order one of the medical tests, procedures or treatments on the list... just say no! (But then, talk it through.)

Read more:

The Choosing Wisely Announcement from JAMA

Kaiser Health News' Overview of Choosing Wisely

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Comments
April 4, 2012 at 6:19 pm
(1) David Moskowitz MD FACP says:

Here’s a 46th: kidney dialysis. I published how to prevent 90% of it in 2002, but my paper was never paid any attention. As a result, nobody has heard that dialysis is obsolete. Interestingly, even Medicare had no interest in eliminating dialysis when I explained my paper to them in 2004. For the paper, go to http://www.genomed.com, click on “Publications” and then click on #1. For how it’s been ignored, click on #9. And if you have diabetes or high blood pressure and don’t want to go on the kidney machine, click on “Contact Us,” and I’ll email you right back.

May 30, 2012 at 8:24 pm
(2) Isabel says:

No. The premiums will not go up for that. Usually hatleh insurance is up for renewal once a year and the cost increases at that time, but not just because you use your policy. The cost of group hatleh insurance where I work has had double digit increases in the premiums every year for 10 years now. The hatleh insurance companies are out of control. If you have insurance and need hatleh care go get the care you need.

July 16, 2012 at 12:44 pm
(3) Reina S. Weiner says:

Although money may be the motivation for some physicians choosing too many tests for patients, there are likely multiple factors prompting those decisions. Many physicians are concerned about malpractice (“my colleagues order those tests”). In addition, patients will request more tests creating unnecessary exposure and expense. Often, less is more.

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