Physicians on Inappropriate Medical Care

The ABIM Foundation has worked with several physician specialty societies to identify items of medical care that may be especially prone to inappropriate overuse.  The goal is to encourage both physicians and patients to be aware of these items and to thoroughly discuss appropriateness before the care is ordered.  Each society produced a list, in somewhat easy to understand language, of five items that should be discussed.  (ABIM Release)  (Choosing Wisely Site)   In addition, a variety of organizations like Consumer Reports, the Leapfrog Group and the National Business Coalition on Health will work to publicize the lists and encourage patients to be better consumers.  The specialty groups include the American College of Physicians, the American Academy of Family Physicians, the American College of Cardiology and the American College of Radiology, and others who in total likely represent a large majority of American Physicians.

The items of care on the lists are those for which there is significant evidence that they have little benefit for most patients.  Some examples include screening exercise electrocardiograms for asymptomatic and low-risk individuals, imaging studies for patients with non-specific low back pain, chest x-rays before surgery, using antibiotics for most cases of sinusitis, doing PAP smears on women under 21, brain scans after a fainting episode and routine cancer screenings for dialysis patients with limited life expectancy.  It is encouraging to see physicians taking the lead in educating themselves and patients on often expensive care items that are of little value.  If physicians and patients working together significantly reduced inappropriate use, quality would likely not suffer.  The impact on costs, however, is uncertain, because other research has suggested there may be as much underuse as overuse of much medical care.