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Ever since the proposal of Obamacare, American medical experts have been looking for ways to avoid rationing medical care to reduce costs, but rather to avoid waste in medical care to reduce costs and also to improve outcomes for their patients.
Three years ago, Dr. Howard Brody of the University of Texas Medical Branch challenged American doctors to identify common tests that don't make a difference in good medical care. Since early 2013, the American Board of Internal Medicine Foundation and consumer watchdog organization Consumer Reports have collaborated in the Choosing Wisely campaign, alerting doctors to procedures that lack a scientific basis.
Through the Choosing Wisely campaign, the American College of Surgeons recommends that oncologists stop:
- Removal of lymph nodes (a procedure that often results in lymphedema, uncontrollable swelling in the arms) in women treated for stage I or stage II breast cancer, without a procedure called sentinel node biopsy, which can show that lymph nodes are not yet cancerous.
- Routine colonoscopy of people whose life expectancy is less than 10 years who do not have a personal or family history of colon cancer. This change would eliminate routine colonoscopies for most people over the age of 75.
Also, the Commision on Cancer recommends that doctors avoid:
- Starting cancer treatment before determining the extent of the cancer and discussing the treatment plan with the patient.
- Performing major surgery on the chest or abdomen without first making sure that breathing passages can be kept open in case of pneumonia and there are veins available for administering IV pain medication.
- Using surgery as a first line of treatment for cancer without considering whether other methods would offer better quality of life.
- Performing mastectomy for breast lumps that are not known to be cancerous unless a needle biopsy cannot be done.
Also the Commission on Cancer recommended that cancer doctors plan for success. Cancer patients should be subjected to follow-up cancer monitoring without the doctor offering the patient a "survivorship plan," an outline of what future treatment will be, before testing for the recurrence of cancer.
Doctors should not duplicate the efforts of other doctors, and medical procedures should be limited to those that are "truly necessary" and "free from harm," and doctors should avoid the rest.
But what if the best efforts of doctors don't result in remission?
The Choosing Wisely campaign has also created new guidelines for end of life care, for people who have cancer and for people who suffer from other terminal ages.