Alan Bavley | Five tests that doctors say are overused

Alan Bavley
Alan Bavley

When you had that sinus infection this winter, did you ask your doctor for antibiotics? Did she prescribe them?

If so, you were both likely accomplices to our out-of-control health care spending.

Doctors dole out antibiotics for more than 80 percent of the sinus infections they see, even though most are caused by viruses, which don’t even respond to the drugs.

That’s why these prescriptions have landed, at second, on a new list of tests and procedures doctors overuse.

The source of this list? Why, doctors themselves.

Their Choosing Wisely campaign attempts to get a handle on costs by cutting back on things that provide little benefit, or even cause harm.

The Leawood-based American Academy of Family Physicians offered up sinus infection prescriptions and four other questionable practices. Eight other medical specialty societies contributed their own five-item hit lists.

Deb Clements is president of the Kansas Academy of Family Physicians and a professor at KU Medical Center. She’s a fan of the academy’s list.

“To some of my colleagues it comes as a surprise, but I do think they got it right.”

Clements doesn’t believe family doctors do the things on the list to pad their bills. There’s little or no money in it for them. Fear of lawsuits isn’t a big motivator either.

More likely, three other things are in play.

Doctors give in to patient demands, ordering unnecessary X-rays, for example, at the first twinge of low back pain. That’s the first item on the family physicians’ list.

Doctors are slow to change old ways despite new evidence. Viruses weren’t always linked to cervical cancer, so Pap tests were offered broadly, Clements said. Now it’s known that adolescents clear these infections. So Pap tests for women under 21 became No. 5 on the list.

Doctors rely on their own experiences rather than objective data. Clements recalls teaching a class on how to perform an EKG. She discovered her student volunteer had a rare but risky heart condition. Incidents like that may lead doctors to do needless EKGs on healthy patients, No. 4 on the list.

Health care spending in the U.S. now tops $2.6 trillion per year. The Congressional Budget Office estimates as much as 30 percent of that care isn’t needed. But it’s unclear how much can be saved if doctors hew to Choosing Wisely lists.

Unneeded EKGs are done during 19 percent of routine adult exams but cost less than $17 million per year.

Just 1.4 percent of women get unnecessary S-ray osteoporosis screenings, No. 3 on the family physicians’ list. But these tests rack up annual charges of more than $527 million.

Several more medical societies plan to release Choosing Wisely lists this fall.

So it may turn out that with a half billion dollars here, a half billion there, we’ll end up saving some real money.