Question Everything: Identifying Unnecessary Tests, Treatments
Have you seen these lists of common tests and treatments that are often unnecessary--or even harmful? In an effort to reduce the costs of unnecessary healthcare measures, nine specialty groups developed their own lists of Five Things Physicians and Patients Should Question, and the results are pretty interesting. Below, I've included just a few of these recommendations that may be relevant to the clinical laboratory.
- The American Academy of Allergy, Asthma & Immunology includes IgG and indiscriminate IgE testing in allergy evaluations as something to avoid, and also advises against routine diagnostic testing for patients with chronic urticaria.
- The American Academy of Family Physicians recommends against Pap smears for women younger than 21 or who have had a hysterectomy for non-cancer disease.
- The American College of Physicians includes among their recommendations: "In patients with low pretest probability of venous thromboembolism (VTE), obtain a high-sensitive D-dimer measurement as the initial diagnostic test; don't obtain imaging studies as the initial diagnostic test."
- The American Society of Nephrology advises against routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms.
There are 45 recommendations in total--five from each of the nine groups. Hot topics like frequency of mammograms and utility of prostate-specific antigen are mostly avoided, likely increasing the likelihood that the recommendations will be adopted. If enough people act on the guidelines and suggestions here, this could be a valuable step in reigning in unnecessary healthcare spending-but it is, of course, only one part of a much bigger picture.
What do you think about these recommendations--and about the nine specialty groups that were included? What lab tests and scenarios would you add to the list?