The professional societies of 17 medical specialties have recently released a list of 135 medical tests, treatments and procedures they have deemed almost always unnecessary and potentially harmful for patients. The initiative is part of a campaign called Choosing Wisely and is meant to encourage doctors to either avoid or seriously question performing the tests on the list.
I do agree there are dozens upon dozens of tests that are unnecessary. After years of being utilized, many of these extraneous procedures have failed to alter the outcome of treatments for conditions that either tend to resolve themselves or can be monitored less expensively.
For many patients, the first question they ask is, “Why were these tests used in the first place?” Well, as these tests were developed, they were implemented in clinical protocols and became the standard medical practices during their times. However, what many patients fail to remember is that science is a living entity. It is constantly changing and adapting. Unfortunately, it’s also difficult to break old habits, and that’s why today, many physicians continue to use numerous old practices and procedures simply because they have gotten used to them.
One of the problems we currently face is that this type of behavior by the health care system has become extremely expensive, and now the common routine for many doctors is no longer to ‘see patient first, do tests later’ – but instead ‘do tests first, see patient after.’
Now, I have to count myself among the many who has relied on the latter behavior for years. To me, one of the biggest motivating factors has never been about the money, but instead protecting myself from litigation. Malpractice lawsuits have prompted many physicians in this country to depend on excessive testing, because they know perfectly well that if they miss a problem, there will be 20 lawyers looking to charge them with negligence. The way these malpractice lawyers operate is by locating paid medical experts – in other words, pitting doctor against doctor – who are more than happy to point out that the reason there was a bad medical outcome was because that doctor failed to do the appropriate test.
One of the more provocative suggestions from the Choosing Wisely initiative concerns Pap smears. According to the American College of Obstetricians and Gynecologists (ACOG), doctors should treat women whose cervical cancer Pap tests found dysplasia – unless the abnormalities persist two years later. However, if cervical cancer is present and the gynecologist fails to identify it, I am sure that in less than a minute, a lawyer would find an expert to say this patient should have been treated earlier.
This is how it goes for many of the ‘unnecessary’ tests listed by the 17 professional societies. At the end of the day, if we want to change the habits of doctors after so many years, then these academies should be more proactive in protecting physicians against litigation instead of simply making broad statements that leave patients and physicians hanging out to dry.