Choosing Wisely

The U.S. spent $2.6 trillion on medical care in 2010. Despite spending much more on medical care than any other developed country, American medical care has mediocre clinical outcomes.

Open discussions between patients and their clinicians about tests and procedures can facilitate the delivery of the right care at the right time. As a pediatrician, I often see parents who come into my clinic with names of tests or procedures for their child that they have read or heard about. More frequently than not, these parents, when engaged in discussions on evidence-based recommendations, make decisions about their child's care that are reasonable, objective, and surprisingly more conservative than one might intuitively expect.

Earlier this month, nine medical societies in the U.S., representing 375,000 physicians released a 45-item list of commonly used procedures that they no longer recommend we automatically order. A major goal of these recommendations is to reduce wasteful spending without harming patients, as well as to prevent adverse effects of overuse, such as radiation exposure.

The list includes reconsidering the routine use of a number of tests and procedures. Among them, annual EKGs for low-risk patients with no heart symptoms, repeat colonoscopies within 10 years of the first, chest X-rays before outpatient surgery, early imaging for back pain, CT or MRI scans for in patients who faint but did not have seizures, antibiotics for chronic sinusitis, osteoporosis screening using DEXA scans in younger patients, and cardiac stress tests for patients without coronary symptoms.

These recommendations provide a springboard for engaging clinicians and patients in discussions about wisely choosing diagnostic and treatment options.

Click here to read more about these recommendations.

- Ulfat Shaikh

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