Less is More

Steven R. Peskin, MD, MBA, FACP

On April 4, the American Board of Internal Medicine Foundation launched Choosing Wisely, a campaign to educate health care professionals and consumers about tests or procedures that should be questioned because of lack of evidence that they’re needed and/or because of evidence that says the tests or procedures should not be done in the context that is delineated. http://abimfoundation.org/.

The ABIMF did this in collaboration with nine medical professional societies — the American Academy of Allergy, Asthma & Immunology; the American Academy of Family Physicians; the American College of Cardiology; the American College of Physicians; the American College of Radiology; the American Gastroenterological Association; the American Society of Clinical Oncology; the American Society of Nephrology; and the American Society of Nuclear Cardiology. Consumer Reports is also involved with this campaign to reach a broad consumer audience.

This initiative marks an important milestone. Historically, most medical professional societies have advocated more, not less. Each of the nine organizations involved in Choosing Wisely is explicitly recommending that many commonly ordered tests and procedures that are routinely done in a particular situation not be routinely done. Three representative examples:

  • Don’t do imaging for uncomplicated headaches (American College of Radiology)
  • Don’t do screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary artery disease (American College of Physicians)
  • Do not repeat colorectal cancer screening (by any method) for 10 years after high quality colonoscopy is negative in average risk individuals (American Gastroenterological Association)

The mantra of “less is more” is one that has been largely overwhelmed by campaigns spouting that “more is better” when it comes to health care related testing and services. Think about the conventional lexicon as it relates to medical testing and procedures: “The doctor gave me....” or, “I was given….” Negative potential health consequences — for example the considerable radiation exposure with CT scanning — as well as cost consequences, are often underappreciated. Eight more medical professional societies have stated that they will join this campaign. Keep up the good, and much needed, work!

Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey — Robert Wood Johnson Medical School.

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