Health and Medical News and Resources

General interest items edited by Janice Flahiff

Despite guidelines, too many medical tests are performed before low-risk procedures

Despite guidelines, too many medical tests are performed before low-risk procedures.

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From the 1 June 2015 EurkAlert

Despite guideline recommendations to limit medical tests before low-risk surgeries, electrocardiograms (ECGs) and chest x-rays are still performed frequently, found a study inCMAJ (Canadian Medical Association Journal).

Evidence indicates that for patients undergoing low-risk surgery, routine testing does not improve outcomes and can actually lead to surgical delays, patient anxiety and other issues. The Choosing Wisely campaign, which started in the United States and spread to Canada and other countries, aims to raise awareness of unnecessary tests and procedures among physicians and patients to decrease their use.

“Rates of preoperative testing before low-risk procedures were higher than expected, given current guidelines and recommendations, with a significant degree of regional and institutional-level variation across hospitals in a large, diverse jurisdiction with a single-payer health system,” writes Dr. Sacha Bhatia, Department of Cardiology and the Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, with coauthors.

There was a 30-fold difference between institutions with the lowest and highest rates of ordering preoperative tests.

Previous studies have looked at patients over age 65, whereas this study included all patients over age 18.

“Our finding emphasizes the need for re-evaluation of ordering decisions and clinical pathways for patients preparing for low-risk procedures. In particular, preoperative anesthesia and medical consultations have been shown to increase preoperative testing rates.”

The authors suggest more research to understand why these tests continue to be performed, which may be useful for institutions in improving their ordering practices.

July 20, 2015 Posted by | health care | , , , , , , , | Leave a comment

[YouTube] Question your medical tests? Oh yeah, it’ll make you happy!

Question your medical tests? Oh yeah, it’ll make you happy!.

From the 24 July 2014 KevinMD.com post

Who knew questioning medical tests could be so much fun? Watch Pharrell Williams’ “Happy” with lyrics that advocate more sensible medical testing. James McCormick, co-host of the Best Science Medicine Podcast, wrote this pitch perfect parody.  The ABIM Foundation’s Choosing Wisely campaign educates both physicians and the public to question medical tests and treatments.

 

The ABIM provides links to Things Physicians and Providers Should Question.
Topics include

 

http://www.youtube.com/watch?v=FqQ-JuRDkl8

Related links

Doctors Call Out 90 More Unnecessary Medical Tests, Procedures

 

 

August 21, 2014 Posted by | Health Education (General Public) | , , , , , | Leave a comment

Things Physicians and Patients Should Question – With Lists From Choosing Wisely

Screen Shot 2014-02-01 at 5.27.47 AMThings Physicians and Patients Should Question | Choosing Wisely.

Ever wonder if a medical test or procedure was right for you?
Maybe you read about it, hear it on the news, or came across it on the Internet.

Here’s Web site that just might help in discussions with your health care provider.

From the Choosing Wisely site

Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

This concept was originally conceived and piloted by the National Physicians Alliance, which, through an ABIM Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were first published inArchives of Internal Medicine. 

Recognizing that patients need better information about what care they truly need to have these conversations with their physicians, Consumer Reports is developing patient-friendly materials and is working with consumer groups to disseminate them widely.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

From the List at Choosing Wisely, by the ABIM Foundation

United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

In collaboration with the societies, Consumer Reports has created resources for consumers and physicians to engage in these important conversations about the overuse of medical tests and procedures that provide little benefit and in some cases harm.

Specialty Society Lists of Five Things Physicians and Patients Should Question (for physicians):

Patient-Friendly Resources from Specialty Societies and Consumer Reports:

and more!

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February 1, 2014 Posted by | health care | , , , , , , , , | Leave a comment

9-part series on over-diagnosis (short reads from a health care journalist)

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Over-diagnosis happens when people are diagnosed with diseases or conditions that won’t actually harm them. 

www.shutterstock.com

 

From the 3 October 2012 blog article by Gary Schwitzer at HealthNewsReview.org

Ray Moynihan, a terrific health care journalist who is now pursuing his PhD on overdiagnosis and working as a Senior Research Fellow at Bond University in Australia, kicks off the first of a nine-part series, “Over-diagnosis Epidemic” on TheConversation.edu.au website.

The first part is an introduction, “Preventing over-diagnosis:  how to stop harming the healthy.”

“To put it simply, over-diagnosis happens when people are diagnosed with diseases or conditions that won’t actually harm them. It happens because some screening programs can detect “cancers” that will never kill, because sophisticated diagnostic technologies pick up “abnormalities” that will remain benign, and because we are routinely widening the definitions of disease to include people with milder symptoms, and those at very low risk.”

Other colleagues author the subsequent parts in the series:

Part two: Over-diagnosis and breast cancer screening: a case study

“…But what we found was that the greatest relative reduction in breast cancer mortality (44%) occurred in the youngest age group. These women (aged 40 to 49 years) are not invited for screening. In contrast, women aged 60 to 69 years, who areinvited to screen, had the smallest relative reduction in mortality (19%).

Given that three times as many women aged 60 to 69 (about 60%) participated in Breastscreen (compared to 20% of women aged 40 to 49 years), our finding is not consistent with screening having a major impact on the reduction in breast cancer mortality since 1991.”…

Part three: The perils of pre-diseases: forgetfulness, mild cognitive impairment and pre-dementia

“…Most studies show that only one in ten cases of mild cognitive impairment progress to dementia each year, and many improve. One study that followed outcomes for ten years concluded – “The majority of subjects with MCI do not progress to dementia at the long term.”…

Part four: How genetic testing is swelling the ranks of the ‘worried well’

“..A major concern with such tests is that they’re the beginning of a path toward over-diagnosis, where the potential to develop a disease or being at risk for the disease is strong enough to constitute a label of sickness.

Over-diagnosing includes, but is not limited to, widening disease definitions, early detections of abnormalities that may or may not cause symptoms or death and the use of increasingly sensitive technologies that detect “abnormalities,” the causes and consequences of which are unknown at this time…”

Part five: PSA screening and prostate cancer over-diagnosis

Part six: Over-diagnosis: the view from inside primary care

“..The most common reason general practitioners are sued is because of missed diagnoses. Missed diagnoses also invoke a strong sense of professional failure. So how can general practitioners manage in this sea of uncertainty?

One way is to perform more tests. This is also popular with patients, who perceive that tests ensure nothing serious is missed. What is not well understood by patients (and sometimes also by clinicians) is the potential harm from testing.

The most obvious harm is the cost and resources required; we would quickly overwhelm the health system if we performed an MRI on every patient with back pain. A strong system of primary care results in a health-care system that’s both more efficient and less costly because primary-care physicians are skilled at filtering those with severe disease needing further tests, from those with self-limiting illnesses…

The greatest harm from the increased use of testing, however, is not costs, resources or false positives. Rather, it’s the problem of over-diagnosis.

Clinicians and patients both believe that finding a disease earlier in its process means it will be more successfully treated. But there’s increasing evidence that finding disease early or at a milder stage has paradoxical harmful effects, even reducing survival and quality of life.

Wider availability of more sophisticated tests results in “incidentalomas”, incidental findings that would not have otherwise been diagnosed. The detection of thyroid cancers, for instance, has more than doubled in the past 30 years. But most of these diagnoses are incidental findings from imaging…”

Part seven: Moving the diagnostic goalposts: medicalising ADHD

Part eight: The ethics of over-diagnosis: risk and responsibility in medicine

Part nine: Ending over-diagnosis: how to help without harming

 

 

 

October 13, 2012 Posted by | Uncategorized | , , , , , , , , , | Leave a comment

Self-Affirmation May Break Down Resistance to Medical Screening

From the 21 December 2011 News article

People resist medical screening, or don’t call back for the results, because they don’t want to know they’re sick or at risk for a disease. But many illnesses, such as HIV/AIDS and cancer, have a far a better prognosis if they’re caught early. How can health care providers break down that resistance?

Have people think about what they value most, finds a new study by University of Florida psychologists Jennifer L. Howell and James A. Shepperd. “If you can get people to refocus their attention from a threat to their overall sense of wellbeing, they are less likely to avoid threatening information,” says Howell. Do that, and people are more likely to face a medical screening even if it means undertaking onerous treatment and even if the disease is uncontrollable. The findings will appear in Psychological Science, a journal published by the Association for Psychological Science.

The researchers undertook three studies, each with about 100 students of both sexes. In all three studies, they asked the participants to think of a trait they valued; they chose traits such as honesty, compassion, and friendliness. Participants then wrote either about how they demonstrated the trait (expressing self-affirmation) or a friend (not affirming themselves) demonstrated the trait….

Read the entire news article

December 22, 2011 Posted by | Consumer Health, Psychology | , , , , | Leave a comment

   

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