The Hippocratic Oath all medical professionals swear to uphold includes a promise to do no harm.
In keeping with that spirit, the American Board of Internal Medicine (ABIM) Foundation began its “Choosing Wisely” campaign, asking professional medical organizations to nominate five tests or procedures that they felt were unnecessary, not supported by evidence, overly costly, or harmful to the patient.
It’s one of many campaigns aiming to overhaul the U.S. healthcare system as well as reign in the wasteful spending that contributes to the nation’s $2.87 trillion annual medical bill.
The Impact of ‘Choosing Wisely’
Researchers with the National Institutes of Health (NIH) analyzed the criteria used by 25 specialty societies to rate 135 tests and treatments as of last August.
Of the services chosen to be on a top 5 list, 36 percent were diagnostic tests, 34 percent were treatments, and 30 percent were for population screening purposes.
Evaluating the criteria for inclusion on the lists, researchers found that 76 percent of those services or practices were justified because evidence showed no additional benefit with higher cost or risk to the patient. Overall, nearly half mentioned greater risk and about a quarter mentioned an unnecessarily high cost.
“Our data show that the issue of cost was almost always raised in the context of a service being judged as good as other options but more expensive. We believe that specialty societies should seek greater opportunities to include within their Top 5 lists services that offer only small incremental benefits at much higher prices,” the authors concluded their review, published in the Journal of the American Medical Association.
For example, at the top of the American Academy of Pediatrics’ list is a call to end the routine prescription of antibiotics for viral infections, such as the common cold and sinusitis. Because antibiotics only kill bacteria and not viruses, over-prescribing contributes to antibiotic resistance and the spread of disease, as well as wastes money.
The American College of Medical Toxicology’s top priority is ending the use of homeopathic medications and supplements due to the lack of quality control and evidence of their effectiveness. The American Society of Anesthesiologists’ top two recommendations call for more judicious use of prescription opioid painkillers. Lethal opioid overdoses have quadrupled in the U.S. over the past four decades.
Cutting Back on Unnecessary Diagnostics
At the top of many lists are unnecessary diagnostic tests, many for minor head injuries, headaches, or back problems. While most are used in good faith, some are used needlessly or improperly, especially for patients who are not at high risk for specific complications.
The American Academy of Neurology suggests doctors stop using electroencephalography (EEG) for headache patients. The American College of Radiology makes a similar suggestion. The American College of Emergency Physicians recommends avoiding computed tomography (CT) scans for minor head injuries in patients who are at a low risk for skull fractures and bleeding on the brain.
While the results of the “Choosing Wisely” campaign don’t have any official bearing on how doctors practice medicine, they can help guide their decision-making as they weigh the costs and benefits of the procedures they order.