Foundation releases second list of medical 'don'ts' for America's doctors

The ABIM Foundation said it released its medical "don'ts" to help doctors and patients choose wisely and reduce health care costs.

Some examples: Physicians shouldn't use feeding tubes for patients with advanced dementia or automatically order CT scans to evaluate children's minor head injuries.

"More is not always better," said Daniel Wolfson, the executive vice president of the foundation, which is affiliated with the American Board of Internal Medicine. "The current question is what not to do because it is wasteful or has side effects."

The nonprofit American Board of Internal Medicine certifies doctors of internal medicine and aims to improve the quality of health care.

The list, which combined the recommendations of 17 medical groups, was released Thursday. The 90 procedures mentioned involve palliative medicine, neurology, gynecology, pediatrics, rheumatology and other disciplines.

According to the foundation, the radiation from a CT scan can increase a child's cancer risk. About 50 percent of the children who visit hospital emergency departments with head injuries have CT scans. The list recommends that doctors observe children before deciding on CT scans.

As for feeding tubes for patients with dementia, the American Geriatrics Society says assistance in oral feeding is better, the foundation said. The society describes the treatment as more humane and comforting, since feeding tubes can be painful.

Last April, the foundation first launched a "don'ts" list that had 45 items. This week's 90 recommendations are in addition to the first 45. A third list will be published later this year.

The medical groups that participated will share the recommendations with their collective membership of 725,000 doctors.

Consumer Reports will translate the results into brochures, videos and articles for patients. The material, in Spanish as well as English, will explain the technical terms and specific recommendations with headlines such as "Allergy tests: When do I need them?" and "Hard decisions about cancer."

"Our surveys show that patients think that every screening has got to be good," said John Santa, the director of the health ratings center at Consumer Reports. "Our health care system pays item by item. So doctors, hospitals and drug companies are encouraged to use more."

He added that advertising often spurs patients to demand certain drugs or procedures, and that experts estimate that 30 percent of treatments are wasteful.

With the help of the lists, doctors and patients should start conversations with each other, Santa said.

The initiative began when Howard Brody, the director of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston, wrote a 2010 editorial in The New England Journal of Medicine that said doctors were partly responsible for rising health care costs.

He proposed that every medical specialty name five common procedures that are expensive and lack benefits.

Today, he said he was encouraged by what he saw.

"It's a challenge for doctors to look in the mirror and say, 'Maybe not everything was good,' " he said. "It's a first important step, but now their behavior has to change."

Otherwise, Brody said, insurance companies might stop paying for those treatments rather than letting physicians make the decisions. In those cases, exceptions wouldn't be considered.

"If a physician sits on his hands, that's crazy. If doctors don't take the leadership, somebody else will do it. And that's not as good for the patient," Brody said.

For future reports, the campaign has the financial support of a $2.5 million grant from the Robert Wood Johnson Foundation.

"Now we want to drive things down to local communities," Wolfson said.

For more information on all 90 recommendations, go to www.choosingwisely… tient-lists/

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