Do You Really Need that Test?

Who among us has not asked a doctor: Is this test or procedure that you’re recommending really necessary?

On the surface it seems like a foolish question. Why would a doctor recommend anything that was not necessary? But it happens. The doctor might be suggesting it as an option, not meaning to imply it was critical. Or the doctor might recommend it out of a surfeit of caution. Alternatively the doctor could be mistaken or out of date — guidelines on tests change. There are many reasons. Is it possible that your doctor might suggest a test or procedure that can be avoided or is not needed? Yes. As a patient, how would you find this out?

The Choosing Wisely Campaign is a brilliant idea implemented by the American Board of Internal Medicine (ABIM). More than 60 medical specialty organizations have responded to the challenge from ABIM to create a list of “5 Things Physicians and Patients Should Question.”

The goal is to stimulate conversations about the best care. ABIM urges doctors and patients to choose care that is supported by evidence, not duplicative of other tests or procedures already received or tests that are not truly necessary.

I reviewed the 5 Things list developed by the American Academy of Ophthalmology first, because that specialty is in the news. Ophthalmology has the dubious honor of coming in first for the biggest billers to Medicare. In 2012 (the year the data was released for) Medicare paid ophthalmologists $929 million for cataract surgeries and $707 million on eye exams. That’s a lot of exams.

The Choosing Wisely page’s first “thing” to question is preoperative medical test for eye surgery, unless dictated by a specific medical indication. An example would be that an EKG is only needed if a patient has heart disease. I found this interesting because a couple of years ago my mother was required to undergo a stress test and have a checkup to clear her for surgery by her internist before each glaucoma surgery. Maybe we should have questioned that recommendation.

The other suggestions seem helpful too, including the last one outlining alternative measures to use before resorting to punctal (or tear duct) plugs for dry eyes.

As a practical matter, it’s best to read the list before the doctor visit. I wish I had! My annual check-up was last week and my doctor gave me an EKG. As I wrote this blog I scrolled through 15 things that the American Academy of Family Physicians flagged (those docs must be overachievers with 15 instead of 5!). Number 4:  Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms. Dang. Now I have to ask my doc why she did the test even though I have no symptoms or family history. I love my doctor and I’m pretty sure she’ll have a great answer. But it’s always an awkward conversation to have after the fact. If only I’d read the listing before the check-up!

Many thanks to ABIM for heading this public service. And have that conversation with your doctor – it’s your body and your care!

Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.

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