Choosing Wisely Initiative a step forward in effort to curb unnecessary imaging

An article at Annals of Internal Medicine lauds the Choosing Wisely initiative as a means to reduce unnecessary tests, including inappropriate imaging.

The American Board of Internal Medicine Foundation and Consumer Reports magazine enlisted nine other leading medical organizations in the initiative, which listed 45 medical services the medical community believes are over-prescribed. Twenty-four of those 45 were related to diagnostic imaging.

The authors, Vijay Rao and David Levin of Thomas Jefferson University Hospital in Philadelphia, note that the American College of Cardiology created its own list 37 overused tests, including 18 imaging studies--13 commonly performed by radiologists and five commonly performed by cardiologists.

They say defensive medicine figures prominently among the reasons for the overuse of imaging, but they also point to equipment installed in nonradiologists' offices acting as an incentive to use it, as well as patients asking for imaging after hearing about it from friends or others. Inappropriate imaging proliferates also when radiologists fail to act as gatekeepers. They, of course, have their own incentives--the more tests they do, the more they earn.

In addition to the costs involved, though, unnecessary imaging exposes patients to unnecessary radiation, inconvenience--and might be part of a rabbit's-hole of tests that leave patients suffering from extreme anxiety, if nothing else, as a New York Times article points out.

Patients told the Times writer of  "being caught in a unending maze of testing and specialists who seem to forget the patient's original complaint."  Doctors and nurses are frustrated by a system that encourages excesses, too.

Rao and Levin call on radiologists to step up in their role to say no when imaging is inappropriate. They also point to greater use of the American College of Radiology's evidence-based appropriateness criteria, which increasingly are being incorporated into computerized decision-support tools.

They note that imaging overall appears to be on the decline overall, as FierceHealthIT has reported, suggesting that efforts to curb inappropriate imaging are kicking in to some degree. But they say increased physician knowledge and understanding of appropriateness criteria will greatly benefit patients and the health care system as a whole.

To learn more:
- read the IAM article
- here's the Choosing Wisely website
- check out the Times story