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    Beware legal ramifications of unnecessary tests

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    George F. Indest III
    Earlier this year, nine medical specialty groups each released lists of the top five medical tests and procedures that are overused and often unnecessary in their areas of medicine. They did so as part of an initiative by the American Board of Internal Medicine (ABIM) Foundation to reduce healthcare spending and improve care. Each list also included information about when a test or treatment may be appropriate based on clinical evidence and guidelines.

    The lists cover a wide range of tests, procedures, and treatments, including stress tests, nonsteroidal anti-inflammatory drugs, electrocardiograms, and immunoglobulin G testing. Some of the services routinely are used, whereas others are appropriate only for some patients, such as those with certain cancers. Many of the tests listed by these specialty boards can lead to unneeded invasive procedures, overtreatment, unnecessary radiation exposure, and misdiagnosis.

    The American Academy of Family Physicians and the American College of Physicians were among the medical specialty associations that released lists. Eight more specialty associations also will release lists of tests and procedures later this year.

    LISTS FOSTER DISCUSSION

    The medical specialty groups decided to create these lists as part of the ABIM Foundation's Choosing Wisely campaign, an effort aimed at promoting an educational dialogue between physicians and patients. Patients are being urged by these medical specialty associations to actively question their doctors when any of the listed tests or procedures are recommended.

    In many cases, doctors may be reluctant to tell patients when a test or procedure is unnecessary, due to their fear of malpractice lawsuits. Now that a list of tests that may not be necessary exists, patients will have access to some of the same information as their doctors, and they can ask whether a test or procedure is warranted. This ability allows shared decision-making between patients and physicians and can result in less uncertainty by patients about the medical care they are receiving.

    Another motive behind the creation of the lists is reducing the occurrence of unnecessary healthcare. The Congressional Budget Office estimates that unnecessary medical treatment accounts for one-third of medical spending in the United States. Because approximately $2.6 trillion is spent on healthcare each year, a reduction in unnecessary procedures would help decrease medical spending and medical costs.

    DOCTORS NOT PLEASED

    This action taken by the medical specialty groups has brought complaints from some doctors. Because of the recommendations, physicians may find it more difficult to address the needs of individual patients.

    Additionally, when physicians perform fewer diagnostic tests and procedures, their income can be reduced, especially under fee-for-service payment schedules that pay for each patient encounter separately.

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