This week newspapers reported assorted medical specialty societies are recommending doctors perform fewer tests and procedures. They also urged patients to question the value of these services, if offered.


Some of the over-ordered tests:

  1. Routine EKG at routine physical
  2. MRI for recent back pain
  3. Imaging studies for patient suffering from simple headaches
  4. Antibiotics for sinusitis.

Two points:


“These all sound reasonable, but don’t forget that every person you’re looking after is unique,” said Dr. Eric Topol, chief academic officer of Scripps Health, a health system based in San Diego, adding that he worried that the group’s advice would make tailoring care to individual patients harder. “This kind of one-size-fits-all approach can be a real detriment to good care.”

Next, the N.Y. Times opined: “Clear, evidence-based guidelines like the ones to be issued Wednesday will go far both to reassure physicians and to shield them from litigation.”

Really? How will evidence-based guidelines shield doctors from baseless litigation? Many such guidelines already exist. It requires little more than one plaintiff’s expert to argue the guidelines did not apply in this unique case. Unless and until such guidelines can serve as explicit exculpatory evidence in court (codified in statute), it will be challenging to get enthusiastic buy-in from doctors.


Finally, often it’s the patient demanding an MR study for three days of uncomplicated back pain. It’s rarely the doctor. So, patients’ expectations will need to be adjusted. This will likely take more effort and education than a simple declaration from organized medicine.