"Choosing Wisely": To Test or not to Test?

Perhaps one of the most important health care innovations in the modern era is our ability to screen for many types of cancer including breast, cervical, and colorectal, among others.  Women, in particular, are inundated with changing recommendations about mammograms and breast cancer screenings, leaving us to constantly question our own self-judgment and that of our doctors.  Unfortunately, our current fee-for-service based system creates false incentives for specialists to order more unnecessary and costly tests rather than reward primary care doctors for good patient care that emphasizes prevention. As reported by the New York Times and CBS News, a new initiative introduced by nine medical specialty boards called "Choosing Wisely," an effort directed at both patients and providers, seeks to change that.  With help from Consumer Reports, the group recommends that doctors perform 45 common tests and procedures less often, and urges patients to question those services if offered.  Here's why:

By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine .

As savvy consumers, we must constantly balance our irrational human want for top-notch medical care (a desire that is frequently borne from misinformation and fear) with sound economic reason about what we actually need.  A key approach to bending the health care cost curve is transparency and getting us all to think about what a medical procedure actually costs, not just the co-pay that you fork over to the receptionist.  As the daughter of a no-nonsense nurse who exercised empathy but objectivity when I wanted to stay home sick from school, I have developed a common sense approach to my health care - mainly I don't go to the doctor when I have a cold.  The financial impact, however, of taking an antibiotic that isn't going to help you (and may potentially harm you) is minimal compared with the growing problem of doctors ordering unnecessary tests and procedures that are driving up our health care costs at a rapid pace, one that is unsustainable.

Perhaps most promising is the initiative's focus on the doctor-patient relationship as a partnership to lower health care spending.  Empowering patients with more information and encouraging them to question their doctors is a good thing.  A core tenet of the Campaign for Better Care is that improving the doctor-patient relationship, namely by helping consumers and their caregivers be good advocates for themselves, also improves quality and reduces costs.  We look forward to seeing how the new recommendations impact patient care.

-Andrea Irwin

Policy Advocate and Staff Attorney