Nine physician organizations identify specific tests or procedures that may be unnecessary

Nine leading physician specialty societies have identified specific tests or procedures that they say are commonly used but not always necessary in their respective fields. Patient advocates are calling the move a significant step toward improving the quality and safety of health care.

To be released at a press conference later this morning as part of the ABIM Foundation's Choosing Wisely campaign, the lists of "Five Things Physicians and Patients Should Question" provide specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. 

The lists include things to question such as:

• Do patients need brain imaging scans like a computed tomography (CT) or magnetic resonance imaging (MRI) after fainting, also known as simple syncope? Probably not. Research has shown that, with no evidence of seizure or other neurologic symptoms during an exam, patient outcomes are not improved with brain imaging studies. (American College of Physicians)
• Do patients need stress imaging tests for annual checkups? Not if you are an otherwise healthy adult without cardiac symptoms. These tests rarely result in any meaningful change in patient management. (American College of Cardiology)
• Should patients going into outpatient surgery receive a chest x-ray beforehand? If the patient has an unremarkable history and physical exam, then no. Most of the time these images will not result in a change in management and has not been shown to improve patient outcomes. (American College of Radiology)
• Do patients need a CT scan or antibiotics for chronic sinusitis? Most acute rhinosinusitis resolves without treatment in two weeks and when uncomplicated is generally diagnosed clinically and does not require a sinus CT scan or other imaging. (American Academy of Allergy, Asthma & Immunology)
• Should dialysis patients who have limited life expectancies and no signs or symptoms of cancer get routine cancer screening tests? These tests do not improve survival in dialysis patients with limited life expectancies, and can cause false positives which might lead to harm, over treatment and unnecessary stress. (American Society of Nephrology)
• Should women under 65 or men under 70 be screened for osteoporosis with dual energy x-ray absorptiometry (DEXA)? No, research has shown that in patients with no risk factors DEXA screening is not helpful in this age group. (American Academy of Family Physicians)

The complete lists from the specialty societies, available at www.ChoosingWisely.org, include additional detail and evidentiary information communicating when a particular test or treatment may be appropriate based on clinical evidence and guidelines.

The nine organizations releasing lists as part of Choosing Wisely represent nearly 375,000 physicians:

• American Academy of Allergy, Asthma & Immunology
• American Academy of Family Physicians
• American College of Cardiology
• American College of Physicians
• American College of Radiology
• American Gastroenterological Association
• American Society of Clinical Oncology
• American Society of Nephrology
• American Society of Nuclear Cardiology

"Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed," said Christine K. Cassel, M.D., president and CEO of the ABIM Foundation. "Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care."

Consumer Reports (CR) – the world's largest independent product-testing organization – is working with the ABIM Foundation and the specialty societies to lead the effort. At today's press conference, Consumer Reports announced eleven consumer-oriented organizations joining Choosing Wisely to help disseminate information and educate patients on making wise decisions. Each of these organizations has the potential to reach at least 1 million consumers.

Those organizations include:

• AARP
• Alliance Health Networks
• Leapfrog Group
• Midwest Business Group on Health
• National Business Coalition on Health
• National Business Group on Health
• National Center for Farmworker Health
• National Partnership for Women & Families
• Pacific Business Group on Health
• SEIU
• Wikipedia community (through a dedicated Wikipedian in Residence)

A 2010 survey of Consumer Reports readers – nearly 1,200 healthy 40- to 60-year-old men and women, with no known heart disease, risk factors or symptoms – showed that 44 percent had received screening tests for heart disease rated by CR as very unlikely or unlikely to have benefits that outweigh the risks.

"By identifying tests and procedures that might warrant additional conversations between doctors and patients, we are able to help patients receive better care through easy-to-use and accessible information," said James A. Guest, J.D., president and CEO of Consumer Reports. "We're looking forward to being a part of this innovative effort working with the ABIM Foundation, the specialty societies, and our eleven consumer communications collaborators to get this important message out to diverse populations of patients."

The Choosing Wisely campaign is designed to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources in the United States. By creating and releasing today's lists, the groups aim to stimulate discussion about the need – or lack thereof – for many frequently ordered tests or treatments, many of which are requested by patients. The groups also hope to support physician and patient relationships by encouraging specific conversations about appropriate individualized testing and treatment plans.

As the nation increasingly focuses on ways to provide safer, higher-quality care to patients, the overuse of health care resources is an issue of considerable concern. Many experts agree that the current way health care is delivered in the U.S. contains too much waste – with some stating that as much as 30 percent of care delivered is duplicative or unnecessary and may not improve people's health. In fact, such unnecessary care may harm or hinder patients' health.

All the lists released today as part of Choosing Wisely were developed by the specialty societies after months of careful consideration and review. Using the most current evidence about management and treatment options within their specialty, the "Five Things" lists include recommendations that can make a significant impact on patient care, safety and quality.

First announced in December 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies will now work with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician's role in helping patients make wise choices.

In addition, the campaign announced eight new participating specialty societies:

• American Academy of Hospice and Palliative Medicine
• American Academy of Otolaryngology–Head and Neck Surgery
• American College of Rheumatology
• American Geriatrics Society
• American Society for Clinical Pathology
• American Society of Echocardiography
• Society of Hospital Medicine
• Society of Nuclear Medicine

These new societies will release their lists in fall 2012.