Unnecessary Care

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Just Say No: Doctors’ Groups Define More Unnecessary Tests, Procedures

CT scan 13 of Clubs_Flickr

One new recommendation: Don’t automatically do a CT scan to check a child’s minor head injury. (13 of Clubs/Flickr)

One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.

On Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit.

This “Choosing Wisely” campaign is from a coalition of doctors’ groups — ranging from the American Academy of Pediatrics to the Society of Thoracic Surgeons — in conjunction with Consumer Reports. Last year, the campaign named 45 tests and procedures patients should look at carefully. This year, 17 doctors’ organizations representing 350,000 physicians released 90 additional tests and procedures. Continue reading

Mammograms: Strong Evidence That Every Two Years Is Best Option For Older Women

(Photo: U.S. Navy)

(Photo: U.S. Navy)

A major new study has found that — in older women — mammograms done every two years were as effective as mammograms done annually and led to far fewer false positive results.

The study, published online Tuesday in the Journal of the National Cancer Institute, included more than 140,000 women ages 66 to 89 from across the country.

Frequency of mammograms among women in their 40s and 50s has been the subject of intense debate for more than two decades, but this older group of women has been much less studied.

The women screened annually had a dramatically higher rate of false positives.
A team led by researchers at UC San Francisco sought to answer the question: among older women, if a woman is screened for breast cancer every two years, instead of every year, will a deadly cancer be missed?

“We found that there really was no difference,” Dejana Braithwaite, assistant professor of cancer epidemiology at UCSF and part of the research team, told me. “The women who were screened every two years were not at a greater risk. They did not have a higher probability of being diagnosed with late stage breast cancer compared to those women who were screened every year.” Continue reading

Please, Don’t Call It Rationing

New Campaign Urges Doctors to Avoid Unnecessary Tests

(Just Us 3: Flickr)

To many patients, it may seem unbelievable that their doctors would recommend something that is completely unnecessary. But by some estimates, that’s exactly what happens a third of the time.

Yesterday a broad coalition of medical specialty groups — including cardiologists and family practitioners — as well as Consumer Reports announced a new campaign, Choosing Wisely. It’s a list of 45 tests and procedures that doctors should do much less often for one simple reason: the items on the list are unlikely to be of benefit to the patient.

The idea immediately raised questions of rationing and that’s exactly where KQED’s Forum started off this morning in discussing the new campaign. UCSF’s Dr. Catherine Lucey, who helped to spearhead the Choosing Wisely campaign, swatted that misconception away.

“It’s not rationing,” she explained. “Rationing of health care is when you deny needed care to patients. … Rationing of health care means patients could get better being given a particular drug of subject to a particular test. This is about tests that in many circumstances do not improve quality of life, do not improve quantity of life and potentially could harm patients.”

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Should Older Adults be Screened for Cancer?

(Jason DeRusha: Flickr)

(Jason DeRusha: Flickr)

Right about now, you might be thinking you’ve heard enough of cancer screening. From mammography to prostate cancer, cancer screening tests have been much debated this fall. Should a 40 year old woman get a mammogram or not? Should men abandon the PSA test? Yet another study released this week looks at a surprisingly unexplored group–older Americans.

Researchers wanted to look at this group because of an “ambiguity of recommendations” for them. While it seems like there’s some ambiguity for the rest of us, the ambiguity here is particularly surprising since age is perhaps the most significant risk factor for many cancers.

Continue reading