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Doctor groups diagnose when tests are overdone

BY DR. DAVID LIPSCHITZ Published: April 30, 2012
Leaders in the field of medicine are embracing the fact that we do far too many unnecessary tests and procedures that could account for a third to a half of our $3.2 trillion annual health care spending.

In the past few weeks, nine major medical groups have each come up with five commonly ordered tests in their practices that are overused.

This is part of the "Choose Wisely" campaign that is led by the American Board of Internal Medicine Foundation and Consumer Reports.

Here are some of the tests and recommendations that many believe are overused. Not all groups and all recommendations are listed here.

Family physicians recommend against X-rays of the lower back during the first six weeks after symptom development; antibiotics for mild-to-moderate sinus infections; a bone-density test for women under 65 or men under 70 who have no risk factors for osteoporosis; and pap tests for women under 21 or those who have had a hysterectomy.

The American College of Physicians, which represents internists, questions the need for a routine EKG if the patient is at low risk of heart disease; CT or MRI scans if the person has fainted or lost consciousness and has no neurological problems; and preoperative chest X-rays if the patient has no lung problems.

Cancer doctors recommend against the treatment of many tumors if the patient is weak and frail and there is no proven evidence that treatment will succeed.

Expensive scans — including PET, CT or bone scans — should not be done in patients with early-stage breast or prostate cancer, nor should there be excessive monitoring of patients who have had curative treatment for breast cancer.

Cardiologists recommend against routine exercise stress tests if the patient is at low risk of having heart problems and against stress tests or CT scans of the heart in patients with known heart disease who are symptom-free.

Gastroenterologists recommend the lowest effective dose in the treatment of gastric reflux. If a colonoscopy screening for cancer is normal, the test should not be repeated for 10 years. If small polyps are found, the test should be repeated every five — rather than three — years.

Radiologists recommend that X-rays and CT scans should not be done in patients with uncomplicated headaches, children with suspected appendicitis, who should be evaluated with a less dangerous and cheaper ultrasound, and women with ovarian cysts that are not causing problems.

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