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Many Medical Tests, Procedures Not Always Needed

New Public Service Campaign Questions Overuse of Commonly Ordered Tests
By
WebMD Health News
Reviewed by Louise Chang, MD

April 5, 2012 -- Major medical and consumer groups are coming together to question the carte blanche use of many commonly ordered tests and procedures, including MRI for low back pain and exercise EKG tests in people with no symptoms and low risk for heart disease.

Sometimes these tests can be lifesavers. Other times they are unlikely to do anything except increase costs and anxiety and expose people to unnecessary risks.

So how do you know the difference?

To help answer this question, nine major medical groups have come up with five commonly ordered tests, procedures, or treatments in their field that are overused. The "Choose Wisely" campaign is led by Consumer Reports and the American Board of Internal Medicine (ABIM) Foundation. It aims to get the doctors and patients to think twice about certain tests in certain situations.

Questionable Tests, Procedures

So what tests and procedures should you question, and when? Here are some examples of items on the list of 45 things doctors and patients should ask about:

  • Exercise stress tests during routine physicals if you are at low risk for heart disease
  • Imaging tests for non-specific low back pain that can't be attributed to a disease or condition after a doctor takes your history and examines you
  • Antibiotics to treat an uncomplicated sinus infection; sinus infections are mostly caused by viruses, which do not respond to antibiotics.
  • Imaging tests such as a CT scan or MRI if you faint and have no other neurological symptoms
  • Chest X-ray, cardiac stress test, or imaging before non-heart surgery
  • Dual X-ray absorptiometry (DEXA) for osteoporosis screening if you are a woman under 65 or a man under 70 with no risk factors for osteoporosis

This is not to say that these tests or treatments are never needed, says ABIM Foundation president and CEO Christine Cassel, MD. "They are sometimes necessary and often overused," she says. "No treatment and no test, no matter how routine, is without some risk."

For example, many of the groups focused on imaging tests such as DEXA, CT scan, and MRI. All of these tests expose a person to potentially harmful radiation. "When a doctor does a physical exam and takes a thorough history, they can say, 'Maybe you should have this,' but they should not be using these as routine things for everybody."
 

James Fasules, MD, agrees. He is the vice president of advocacy for the American College of Cardiology (ACC) in Washington, D.C. The ACC is one of the nine medical groups involved in this campaign. "You can make a diagnosis or treat a patient without ordering an imaging test," he says.

The new recommendations are "not absolutes, but they should give you pause."

Experience counts. "Experienced physicians always have the ability to step back and say in this patient, 'We should do this,' but don't have to do it in patient after patient after patient."

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