Yesterday, the ABIM Foundation's Choosing Wisely initiative released a list of 45 medical procedures in nine specialties that doctors shouldn't use, and that patients should know are not necessary. The procedures include a variety of treatments, screening tests, and diagnostic tests, including: MRI and CT scans for low back pain without red flags; cardiac imaging tests for patients with chest pain and low risk of complications; brain imaging for a simple headache; and curative treatment for cancer patients when there's no reason to think the treatments will work. All of the recommendations are based on solid medical evidence that the procedures harm patients, provide no benefit, or provide extremely small benefits at very high costs.
It's remarkable that the ABIM Foundation was able to pull together panels of people in all of these specialties (allergy, asthma, and immunology, family medicine, cardiology, general internal medicine, radiology, gastroenterology, clinical oncology, nephrology, and nuclear cardiology) who were willing to agree that these treatments and tests are not beneficial to patients. It speaks to the strength of the evidence against performing useless treatments.
Dr. Vikas Saini, a cardiologist and president of the Lown Cardiovascular Research Foundation, has more commentary over at his blog:
"The truth is, guidelines and appropriate use criteria are used sparingly in practice. Occasionally, in a tough case. But there is such a guideline explosion, you need a guideline for the guidelines. I don’t blame practicing clinicians when they ignore them. If we are to tackle this problem seriously, what we need of our doctors needs to be baked into their (our) daily cognitive frames, habits, and attitudes."
Take a look at the whole post--it's definitely worth a read.
We'll certainly be covering this initiative as it continues--there are another eight or more specialty societies preparing lists now, for release this fall, including hospice and palliative care, geriatrics, and hospital medicine. Be sure to check out the website for the Avoiding Avoidable Care conference, as well (avoidablecare.org)--we'll be talking about a lot of the same issues!