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Editorial: More discussions, restraint could improve health care

Feb. 27, 2013 @ 10:10 PM

Many people who see a doctor about sickness or injury simply do what the doctor orders, taking whatever medicine is prescribed, undergoing this or that test, or perhaps agreeing to a particular procedure. Some people take the other extreme, requesting tests or treatments that the doctor didn't suggest in the first place.

But there's a growing movement in the country advising patients to not be so agreeable, at least not without first asking a lot of questions, and urging doctors to avoid unnecessary services. Its participants suggest that many treatments often aren't warranted and can cause harm, depending on the circumstances.

Surprisingly, the cautions and warnings are coming from doctors. They are part of a coalition of medical specialty groups that have formed a program called Choosing Wisely.

The program was launched by the American Board of Internal Medicine Foundation, which was joined by nine medical specialty societies last year to develop a list of tests and procedures for patients and physicians to question. Last year, the coalition listed 45 overused tests and treatments, including doing too much imaging for back pain and repeating colonoscopies too frequently.

This year's list details 90 more overused kinds of care. One recommendation is to avoid surgical screening of a healthy person to determine whether a neck artery is clogged if a patient shows no worrisome stroke signs. Another example is to avoid routine use of heartburn medicine for infants with reflux, a pediatric group advises, because the medicine hasn't been proven to work in babies and could cause side effects.

At this point, a total of 25 medical societies representing more than 350,000 doctors are helping to develop the list of treatments to question.

The ABIM Foundation said it started the program because it recognized that patients often ask for tests and treatments that aren't necessarily in their best interest. In addition, physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases. Through Choosing Wisely, the foundation aims to promote wise choices by doctors to improve health care results, provide care that avoids unnecessary and even harmful interventions, and reduce the rapidly-expanding costs of the health care system.

Too many people "think that more is better, that more treatment, more testing somehow results in better health care," Dr. Glen Stream, former president of the American Academy of Family Physicians, told The Associated Press. "That really is not true."

Unnecessary testing, medication and procedures also drive up the nation's health care bill -- something that most all of us pay for in one way or another -- and may hamper or slow access to care for those who really need it.

The key message for doctors and patients is to become better informed about testing and treatments and, most of all, talk to each other about whether they are really necessary. If those serious discussions take place, the result is likely to be better care and less waste.



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