Millions of people in the U.S are being subject to overtreatment and overtesting in one form or another. Some people receive drugs that aren't helping them, procedures that aren't going to make them better, or scans and tests that do nothing beneficial for them, and often cause harm.
Unnecessary lab testing appears to take thousands of dollars out of the paychecks of every household each year, and contributes to the estimated $910 billion wasted each year in U.S. health care.
Most experts consider this level of healthcare spending, which continues to increase, unsustainable, blaming unnecessary diagnostic and screening tests as a primary driver of it.
These tests are not only financial burden, but also an important patient safety issue. The significant number of tests can lead to incidental findings that usually result in unnecessary follow-up testing and potentially harmful interventions. Some patients can even develop anemia and other associated complications from overtesting.
But, are doctors to blame for this epidemic of unnecessary medical care that is harming patients physically and financially? Not necessarily.
Many patients request (or receive) routine medical tests that are in the same time unnecessary, mostly because of financial or legal reasons, as well as their inertia to change well-established things, such as diagnostic testing that has been done for years.
However, medical providers are to blame. They should be able to determine if their patients require certain test or procedures or not. But, for the busy primary care providers, deciding what test to order or not for various medical conditions can sometimes be challenging, especially without clear guidance.
Fortunately, there are a lot of resources that could help medical providers make this decision. You can read our review of The Ottawa Rules app that helps emergency medicine, primary care and orthopedics providers make better decisions on reducing unnecessary imaging to evaluate patients with various bone injuries.
Patients are no different. They also need a similar guidance on deciding if they really need certain test and procedures. Of course, making this decision requires the physician's advice and support.
Several medical societies have been working together to identify the common tests, procedures or treatments that are commonly overused, such as the American Board of Internal Medicine (ABIM) Foundation that created the "Choosing Wisely" initiative.
This initiative that gathers around over 70 medical societies, associations and partner groups with a goal to list common medical tests, procedures or treatments that are often clinically unnecessary.
The Choosing Wisely initiative has partnered with Consumer Reports to create a website that offers guidance and recommendations about these types of decisions, as well as videos and other downloadable materials for patients and providers.
As an additional effort, Choosing Wisely and Consumer Reports have launched Making Healthy Choices app for iOS, with a goal to provide the recommendations to the patients and empower them to use less unnecessary tests and procedures.
Upon starting the app, you'd see that it covers not only tests and procedures, but medications as well. There are three sections on the main screen, first that provides information on necessities of certain test and procedures, second that covers drugs, and third section that provides 5 questions that every patient should ask their doctor or healthcare provider as well as video that better explains Choosing Wisely initiative.
Procedures and test are featured as simple list with items grouped in three more sections that include Screening and diagnostic tests, Imaging and scans, and Treatments and procedures.
First section covers common test such as allergy screening, annual physical exam, colonoscopy, CBC, ECG, mammogram, and other screenings. Second section features CT scan, X-ray and other scans, while the last section provides recommendations for various treatments and procedures, including antibiotic use, delivery, surgery, and so on.
Tapping on any entry would open new screen with relevant information provided in a form of small info sheets or boxes (single or multiple, depending on the topic). Each box contains brief piece of information or recommendation, with the name of the resource used, and link to more detailed information on Consumer Reports Health website, which is also available as PDF (both open within the app).
Recommendations on drugs are not featured as a list. There's a search field that allows users to look for the medications they use and check if they're necessary. Fortunately, auto-complete option makes the search easier.
Information about medications is provided in same fashion, i.e. via info boxes that provide brief information, with link to detailed Consumer Reports recommendations. Also, users can learn more about the drugs on Medline Plus website, as well as FDA approved formulations with drug labels and images.
However, not every drug is covered with recommendations, but the app would still provide you with the Medline Plus link and formulation info.
Some of the recommendations also contain videos that link to Consumer Reports channel providing more relevant information about the topic. Keep in mind that you will need internet connection in order to view videos and PDFs, so be sure to enable WiFi in order to avoid any costs.
Also, there's another thing to keep in mind. While the evidence behind the Choosing Wisely recommendations is mostly legit, some of it, particularly recommendations for primary care have been publicly criticized, so be sure that you carefully read each recommendation to see the evidence upon which it is based.
It is necessary to include your healthcare provider into this process, because making the decisions about such important questions that include necessity of testing, procedures and treatment, can be only done that way – with your healthcare provider.
The Making Healthy Choices app has its flaws, but it is still very good app that brings the important recommendations and comprehensive information to patients in an easy to understand format. However, healthcare providers are still those who should encourage their patients to use this app and empower them to take more active role in their own healthcare.
Benefit: The app is primarily aimed at patients, but could be useful to healthcare providers who care for patients as well