90 Unnecessary Tests And Procedures That Patients Should Discuss With Doctors

The American Academy of Family Physicians and 16 other medical groups released a list today of 90 common tests and procedures that are frequently ordered unnecessarily and can even inflict more damage on a patient.

Unnecessary procedures include using feeding tubes for dementia patients, C-section deliveries for healthy women before 39 weeks of pregnancy, ultrasound tests for ovarian cysts, and CT scans for minor headaches. The list builds on a project initiated last year by the Choosing Wisely campaign, which seeks to trigger informed conversations about treatment between doctors and patients. Choosing Wisely asked each specialty group to come up with a list of 5 tests and procedures they feel were overused. Twelve other medical societies are expected to release more lists of questionable procedures later this year.

The list released today includes:

• Routinely performing annual PAP tests for women 30 to 65 years old.

• Prescribing antipsychotic medication as a first choice to treat behavioral and psychological symptoms of dementia.

• Prescribing testosterone in men with erectile dysfunction and normal testosterone levels.

• Screening healthy people — with no symptoms — for cancer using a PET/CT scan.

• Treating an elevated PSA in men with antibiotics when no other symptoms are present.

• Prescribing Xanax, Valium, Ativan, and other drugs known as benzodiazepines in older patients as a first choice for insomnia, agitation or delirium.

Alerting patients and doctors to dubious procedures not only helps fine-tune patient care, but could also go a long way toward trimming America’s intimidating health care costs. Even though Americans spend more on health care than any other developed nation ($2.7 trillion each year), the quality of care they receive often falls short. A recent analysis indicated that hospitals that spend more money on their patients are not necessarily giving them better treatment. As Dr. Christine Cassel, President of the American Board of Internal Medicine Foundation, observes, roughly one third of health care costs are wasted on unnecessary tests and procedures.

Furthermore, doctors are traditionally not trained to consider the financial costs of the tests they order, and usually omit financial factors when discussing treatment options with patients. Patients who actively seek out a procedure’s cost estimate have been stymied by wildly ranging prices, from $10,000 to $125,000 for a hip surgery, or $500 to $5,000 for an MRI.

The full list will be updated on Choosing Wisely’s website.