The MRI you got when you hurt your back moving the couch.  The exercise stress test that's part of your yearly physical.  The antibiotics you took for your sinus infection.  These are all targets in a new campaign to improve patient safety by reducing the number of unnecessary procedures, which also cost the nation billions each year. 

It's a sea change in medical thinking one that could have a profound effect on your own health care.  More and more physicians are warning that the overuse of some medical procedures can lead to patient anxiety, dangerous side effects, pain, radiation exposure, unnecessary surgery and even death. 

Now, in what is the largest, most organized campaign of its kind, the American Board of Internal Medicine (ABIM) Foundation has asked doctors in nine medical specialites...from allergists to cardiologists...to each identify five tests or treatments they say are regularly prescribed but often overused or unnesessary.

We're changing the culture in medicine," says Chrstine Cassel, M.D., president of ABIM, about its new Choosing Wisely campaign, which respresents come 375,000 doctors and also includes Consumer Reports.  Cassel acknowledges that the treatments singled out as overused can be valuable, even lifesaving, for the right people with the right symptoms...or with risk factors such as diabetes, high blood pressure, high cholersterol or family health problems.  The goal of this campaign and the whole movement, she says, is to get doctors and patients talking about which treatments are really needed and which aren't. 

What's behind all this unnecessary medicine?  Doctors have grown accustomed to ordering test and treatments, often to protect themselves from malpractice suits.  Patients have come to expect, even demand, drugs and tests for ordinary aches and pains.  they go to the doctor's office to be 'treated' and not to be told that they don't need a CT scan for their headache, experts say. 

The Choosing Wisely campaign says less medicine is often better medicine.  It's not about government rationing care or insurance companies denying that care, says John Santa, M.D. who directs health ratings for Consumer Reports.  It's about protecting patients.  "Too much testing is being done that isn't needed, that doesn't work," Santa says.  But, Americans fervently believe that more is better, says Russell Harris, M.D., an expert in health policy at the University of North Carolina who is not part of the campaign.  He says it's hard to explain how having a test or having extra treatment or extra medications could actually do more harm than good.  "By not choosing wisely...we could actually hurt more people than we help," he says.

Indeed, an estimated 30,000 Medicare patients die each year from unnecessary care, says Elliott Fisher, M.D., a director of the Dartmouth Institute, which studies health care issues.  In addition, up to one third of spiraling health care costs...he estimates...is wasted on unnessessary treatments. 

Steven Nissen, a prominent cardiologist at the Cleveland Clinic, says the current health care system 'rewards excessive testing.'  Physicians often make money when they order tests, and 'there isn't a lot of scrutiny of the appropiatness of that testing.'  And, patients, he says, 'have got to resist this idea that you're better off 'just in case.'  Here are seven of the most popular, most overused tests and treatments for people over age 50 that the AARP Bulletin has selected from Choosing Wisely.  For the entire list go to choosing wisely.org. 

1) Ekgs and stress tests for healthy people without symptoms; (American Academy of Family Phyicians);  A 2010 Consumer Reports surven found that 44 percent of people with no symptons of heart disease had a screening test...an EKG, an ultrasound or an exercise stress test.  That means millions of healthy people each year get EKGs they really don't need.  Moreover, routing screening for heart problems often includes exercise stress tests with the patients on a treadmill, electrodes attached to his chest.

Although these tests can be lifesavers for those with risk factors, 'routing stress testing is a horrible idea,' says cardiologist Nissen.  For those at low risk for heart disease the tests are 10 times more likely to show a false positive result than a real problem.  Like EKGs, stress ecocardiograms...which create pictures of the heart during exercise...frequently yield misleading results.  For several years, cardiology guidelines have discouraged thes test for people who have no symptoms.  And yet their use 'is more common than is nees to be,' says James Fasues, M.D., of the American Collegte of Cardiolory

Dangers:  False positive tests ofter lead to more tests and even invasive procedures. 
Exceptions:  The tests may make sense for people with diabetes or other risk factors.

2)  Bone scans for osteoporosis for women under 65 and men under 70 with no risk factors;  (American Academy of Family Physicians)  With age, bone density decreases and the risk of fractures increases.  Medical groups agree that most women don't need a bone density test until age 65.  But, a number of doctors still recommend the scan starting at age 50. 

Dangers;  Bone density (DEXA) scans can lead to unneeded medications that can have serious side effects. 

Exceptions: Talk to your doctor about having a scan before age 65 (70 if you're a man) if you are or have been a smoker, if you've used steroid medications regularly, if you have low body weight, or if you have had a fracture. 

3) Antibiotics for mild to monerate sinus infections.  (Family Academy of Family Physicians; American Academy of Allergy, Asthma and Immunology;
Despite physicians awareness campaigns about the overuse of antibiotics for sinus infections, the drugs are prescribed in more than 80 percent of these cases.  In fact, the cases account for about 20 percent of all adult antibiotic prescriptions.  More than 90 percent of sinus infections are caused by viruses...and the drugs work only against bacterial infection. 

Dangers; The overuse of antibiototics can leave you can leave you vulnerable to increasingly virulent strains of drug-resistant bacteria. 

Exceptions; If symptoms last for more than seven days or worsen after initially improving.  If you develop a secondary bacterial infection, antibiotics may be needed. 

4) NSAID painkillers for people with high blood pressure, heart failure and any chronic kidney disease. (American Society of Nephrology);  Many people turn to NSAIDs...Advil and Motrin (ibuprofen) or prescriptions such as Celebrex and Voltaren...for pains ranging from arthritis to headaches.  But for those with high blood pressure or kidnay disease, these medications can raise blood pressure, reduce the effectiveness of blood pressure meds, trigger fluid retention and impair kidney function.  A recent study looked at the older people on blood pressure meds who also took NSAIDs.  They found twice as many deaths...mainly from heart attacks and strokes...among those regularly using NSAIDs.  Tylenol (acetaminophen), tramadol or short-term use of narcotic painkillers may be safer than NSAIDs, accouding to the nephrologists. 

Dangers;  NSAIDs are linked to stomach bleeding and increased risk of heart and kidney problems.

5)  CTscans and other imaging for uncomplicated headaches.  (American College of Radiology);  Severe headaches can be excruciating and frightening, but unless they're accompanied by other key symptions, it rarely make sense to get a CT scan or MRI of the brain.  And yet, 'it happens all the time,' says David Seidenwurm, M.D., a neuroradiologist in Sacramento, Clif., who helped craft the recommendation.  Patients get frightened, doctors worry about lawsuits and people want instant information, he says, 'It's easier to do the scan than to have the conversation.'  Doctors also may misinterpret a bend in a blood vessel on a test as a sign of a stroke or aneurysm.  Imaging tests have contributed to a nearby sixfold increase in reaiation exposure since the early 1980's.  Half of all exoposure to radiation now comes from medical tests and procedures. 

Dangers; radiation exposure raises cancer risks in the population, and false positive results lead to more testing and patient anxiety. 

Exceptions; Trouble speaking, blurred vision, weakness on one side or other symptoms may suggest the headache is a sign of stroke or a tumor.

6) Dubious diagnostic tests for suspected allergies.  (American Academy of Allergy, Asthma and Immunology);  Some 35 million Americans suffer from seasonal allergies.  And, millions of Americans increasingly blame a food allergy or sensitivity...from gluten to milk...for their health woes.  Some doctors or health workers now perform a blood test, called an immunoglobulin (IgG), for food allergies.  But, Linda Cox, M.D., of the allergy academy says the test simply doesn't work.  I positive result in and IgG test is the sign of a normal immune system, not a food allergy.  'It leads to a lot of confusion,' Cox says.  If you've been eating any kind of food, there's a good chance you will develop an IgG antibody, she says.  'And that has nothing to do with allergy.'  For seasonal allergies many doctors run a battery of blood and skin tests dubbed IgE, when just a few specific tests would do.  Aby asking patients when and where they have symptoms, doctors can pinpoint what tests to run.

Dangers; The superfluous use of medications; an overly restricted and unbalanced diet.

7) X-ray, CT scan, MRI for low back pain; (American College of Physicians; American Academy of Family Physicians)  Low back pain is the fifth most common cause for all doctor visits.  'The vast majority of people with nonspecific low back pain simply get better, no matter what you do.  And, most of them get better within four to six weeks, with or without a physician's intervention,' says Patrick Alguire, M.D., and official with the American College of Physicians.  And, if older people get an image, experts say, the results will almost always show an innocent 'abnormality' that has nothing to do with the pain.

Dangers: Some tests expose people to unnecessary dadiation and can lead to expensive back surgery.

Exceptions; When the doctor suspects serious underlying conditions or if the pain isn't better in six weeks."

END OF ARTICLE;

My Two -Cents: (comments/opinions)
In my view, the American people are fed up with the  greedy Medical profession, and if you leave it up to the worthless Congress, you'll be dead and gone and so will I. 

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Copyright; 2012; Jerry Aragon; The Humor Doctor