February 13, 2013

In My Opinion: Doctors support Choosing Wisely


---- — Americans pay more for health care than anywhere else in the world, but we don’t enjoy better health than most Western countries.

Insurance companies and the government have tried to reduce payments for many years. HMOs were not very successful in reducing costs. Most politicians will not discuss anything that might be politically unpopular, even if it might be helpful.

Perhaps one thing we can all agree on is that money spent should be spent wisely. Yet experts estimate that in a single year over $1 trillion ($1,000,000,000,000) is wasted on unnecessary medical testing — about $3,000 for every person in this country.

You may wonder why there is any wasteful spending at all. Sometimes, it is because doctors have not kept up with the latest research. Sometimes, patients believe that they should have a test. Finally, some inappropriate testing or treatment may be encouraged by drug companies, medical-device manufacturers or physicians who will make a lot of money if their products are used.

Think about how many television commercials you have seen encouraging us to take medications (Viagra) or get tested for different conditions (“low T”). Most are devised to make money for pharmaceutical companies, not to make you healthier.

Choosing Wisely is a campaign designed to try to reduce unnecessary medical testing or treatment. Choosing Wisely was not designed by the government or insurance companies; it was designed by doctors. Some of the best medical experts in this country have worked together on this project.

The physicians at CVPH Medical Center have agreed that we support Choosing Wisely, and we want to help the community learn more about it.

It is important to stress what Choosing Wisely is not:

1. Choosing Wisely is not rationing. Rationing is when medically necessary tests are not done because we don’t have enough resources. For example, only 10 percent of people who need a heart transplant will receive one, because we don’t have enough donor hearts available.

Choosing Wisely is trying to limit unnecessary tests, not medically necessary tests.

2. Choosing Wisely is not Obamacare. Choosing Wisely is written by doctors. It is not run by the government, insurance companies or HMOs. Medical experts are trying to help you and your doctor do what is best for your health — and maybe save some money at the same time. The government is not involved.

Choosing Wisely was written by medical experts in nine specialties, each recommending five tests or treatments that should not be done.

It is important to stress that Choosing Wisely recommends not doing certain tests in specific situations. For example, it recommends that nuclear stress tests not be done for stable heart patients on a regular basis. This does not mean that nuclear stress tests should never be done, but rather that they be done for the right reason.

Here is a list of some of the other 44 recommendations:

▶ Antibiotics should not be used for most colds or sinus infections. Antibiotics usually don’t help and they carry a risk of side effects, sometimes serious ones.

▶ Most people with back pain lasting less than six weeks do not need X-rays. It is rare that a serious and treatable problem will be found.

▶ Most patients without heart disease, or with stable heart disease, do not need stress tests. The results rarely change treatment but can lead to unnecessary tests or invasive procedures.

▶ CT scans of the head are not necessary for most people who pass out (faint) or who have headaches. They rarely reveal the cause of the problem.

▶ Drugs for treatment of acid reflux or GERD should be used at the lowest doses necessary to control symptoms.

▶ Avoid or limit the use of NSAIDs (ibuprofen, Motrin, Advil; or naproxen, Aleve, Naproxen) in patients with high blood pressure, diabetes, heart failure or kidney disease. There is a small risk of causing kidney problems.

▶ The decision to start dialysis in patients with kidney disease and other serious medical problems is not always helpful; a detailed discussion about the risks and benefits is very important.

If you would like to read more about this, check out

Dr. Joel Wolkowicz is medical director of cardiology and president of the medical staff at CVPH Medical Center.