In the United States, in part because health care is so expensive, there has been a big effort to decrease costs. Many public health experts believe there is much waste in the health care system; that many tests, procedures, and surgeries are unnecessary and actually harmful. Some experts estimate that unnecessary treatment constitutes one-third of medical spending in the United States.
The executive director of the prestigious American Board of Internal Medicine Foundation states “many tests are wasteful, and they could put patients in danger of harm without any benefits….the goal is to begin to change attitudes both from the public side and the physician side that sometimes less is better.”
The Foundation recently asked each of the top medical specialty societies in the U.S.—the associations that control the best trained doctors in the country—to propose up to five ways that health care could be improved, and at the same time, health care costs could be cut. The various societies came up with 90 suggestions. You can read the full list here.
Many of these are written in technical terms directed to doctors, and today we selected 10 of these recommendations and have adapted them into layman’s language. We are presenting them to stimulate thought, and for discussion with your doctor if they apply to you or your family’s health.
1) Don’t undergo computed tomography (CT) of the sinuses or indiscriminately use antibiotics for uncomplicated acute sinusitis.
Viral infections cause the majority of acute sinusitis and only 2% progress to bacterial infections. Most acute sinusitis resolves without treatment in two weeks. Most cases of acute sinusitis can be diagnosed by the patient’s history and exam and does not require a sinus CT scan.
2) Don’t have x-rays for low back pain within the first six weeks, unless warning signs are present.
Warning signs include severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. X-rays of the lower spine before six weeks do not improve outcomes, but do increase costs.
3) Don’t order annual electrocardiograms or any other heart screening tests for low-risk patients without symptoms.
There is little evidence that detection of coronary artery disease in patients without symptoms and at low risk for heart disease improves outcomes. Incorrect test results are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Potential harms of this routine annual screening exceed the potential benefit.
4) Don’t screen for carotid artery atherosclerosis in adult patients who have no symptoms.
There is good evidence that for adult patients with no symptoms of carotid artery atherosclerosis, the harms of screening outweigh the benefits. Screening could lead to non-necessary surgeries that result in serious harm, including death, stroke and heart attack.
5) Don’t prescribe oral antibiotics for uncomplicated outer ear infection.
Oral antibiotics have significant adverse effects and do not treat the bacteria that cause most episodes; in contrast, antibiotic eardrops do cure most of these infections.
We will present five more recommendations from the American Board of Internal Medicine Foundation in our next post.
Esta postagem também está disponível em: Portuguese (Brazil)