WASHINGTON — Doctors should avoid 90 medical procedures that are performed regularly but often cost too much or do little good, according to a new list of expert
recommendations.
The ABIM Foundation said it released its medical “don’ts” to help doctors and patients choose wisely and reduce health-care costs.
Some examples: Physicians shouldn’t use feeding tubes for patients with advanced dementia or automatically order CT scans to evaluate children’s minor head injuries.
“More is not always better,” said Daniel Wolfson, executive vice president of the foundation, which is affiliated with the American Board of Internal Medicine. “The current question is what not to do because it is wasteful or has side effects.”
The nonprofit American Board of Internal Medicine certifies doctors of internal medicine and aims to improve the quality of health care.
The list combined the recommendations of 17 medical groups. The 90 procedures involve palliative medicine, neurology, gynecology, pediatrics, rheumatology and other disciplines.
According to the foundation, the radiation from a CT scan can increase a child’s cancer risk. About 50 percent of the children who visit hospital emergency departments with head injuries have CT scans. The list recommends that doctors observe children before deciding on CT scans.
As for feeding tubes for patients with dementia, the American Geriatrics Society says assistance in oral feeding is better, the
foundation said. The society describes the treatment as more humane and comforting, since feeding tubes can be painful.
Last April, the foundation launched a “don’ts” list that had 45 items. The new 90 recommendations are in addition to the first 45. A third list will be published later this year. The medical groups that participated will share the recommendations with their collective membership of 725,000 doctors.
Consumer Reports will translate the results into brochures, videos and articles for patients. The material, in Spanish and English, will explain the technical terms and specific recommendations with headlines such as “Allergy tests: When do I need them?” and “Hard decisions about cancer.”
“Our surveys show that patients think that every screening has got to be good,” said John Santa, director of the health-ratings center at Consumer Reports. “Our health-care system pays item by item. So doctors, hospitals and drug companies are encouraged to use more.”
He added that advertising often spurs patients to demand certain drugs or procedures, and that experts estimate 30 percent of treatments are wasteful.
Other procedures on the list include:
• Bone-density tests
•Chest X-rays before surgery
• EKGs and exercise stress tests
The initiative began when Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, Galveston, wrote a 2010 editorial in The New England Journal of Medicine that said doctors were partly responsible for rising health-care costs. He proposed that every medical specialty name five common procedures that are expensive and lack benefits.