Doctors urged to cut back on overused tests and therapies

Don't be afraid to question your doctor and ask, "Do I really need that?" That's the advice from leading medical groups who came up with dozens of tests and treatments that physicians too often prescribe when they shouldn't.  

No worrisome stroke signs? Then don't screen a healthy person for a clogged neck artery, the family physicians say. It could lead to risky surgery for a blockage too small to matter.  

Don't routinely try heartburn medicine for infants with reflux, the pediatric hospitalists say. It hasn't been proven to work in babies, and could cause side effects.  

Don't try feeding tubes in people with advanced dementia, say the hospice providers. Helping them eat is a better option.  

 These are examples of potentially needless care that not only can waste money and time, but sometimes can harm, says the warning being issued Thursday from medical specialty groups that represent more than 350,000 U.S. doctors.  

Too many people "think that more is better, that more treatment, more testing somehow results in better health care," said Dr. Glen Stream, former president of the American Academy of Family Physicians, which contributed to the list. "That really is not true."  

The recommendations are part of a coalition called Choosing Wisely, formed by the American Board of Internal Medicine Foundation. Participating medical societies were asked to identify five tests or treatments that are commonly overused in their specialty. The list is aimed at doctors and includes references to published studies.

Consumers Reports and other consumer groups are publicizing the information in more patient-friendly terms. Last year, the coalition listed 45 overused tests and treatments. It included some of the best known examples, such as too much imaging for back pain and repeating colonoscopies too frequently.

This year's list adds 90 more overused kinds of care. Some are the result of doctors' habits, hard to overcome despite new evidence, Stream said. Others come about because patients demand care they think they need. Some other examples:

• Don't use opioid painkillers for migraines except as a last resort, say the neurologists. There are better, more migraine-specific drugs available without the addictive risk of narcotics. Plus, frequent use of opioids actually can worsen migraines, a concept known as rebound headache.
• Just because a pregnant woman misses her due date, don't race to induce labour if mom and baby are doing fine, say the obstetricians. Inducing before the cervix is ready often fails, leading to an unneeded C-section. "Just being due by the calendar doesn't mean your body says you're due," Stream notes.
• Don't automatically give a child a CT scan after a minor head injury, say the pediatricians. About half of children who go to the ER with head injuries get this radiation-heavy scan, and clinical observation first could help some who don't really need a CT avoid it.
• And don't leave an implanted heart-zapping defibrillator turned on when a patient is near death, say the hospice providers. This technology clearly saves lives by guarding against an irregular heartbeat. But if someone is dying of something else, or is in the terminal stages of heart disease, it can issue repeated painful shocks, to no avail. Yet fewer than 10 per cent of hospices have formal policies on when to switch off the implants.