YONKERS, NY — When should patients say “Whoa!” to their doctors?  Consumer Reports has some answers in a new follow-up report to the Choosing Wisely campaign launched in April by the ABIM Foundation.  The coalition of nine physician groups compiled lists of “Five Things Physicians and Patients Should Question” to represent each doctor group.   It’s been estimated that up to 30 percent of health care in the U.S. is unnecessary.

“The Choosing Wisely campaign has made remarkable progress identifying 45 instances in which patients should question their doctors or be receptive when their doctors feel that care is unnecessary.  The next phase is to translate those lists for consumers so they know when to say ‘Hey, doc, do I really need that’?” said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. 

“To help consumers start having those conversations with their doctors, we’re highlighting the risks and costs associated with each test or treatment to illustrate what’s at stake.  For example, if your doctor orders a CT angiogram as a follow-up to a false positive screening EKG —a likely sequence with patients who have no symptoms of heart disease—then you could get exposed to significant radiation.  And to put that in context, we estimate a radiation dose equivalent to hundreds of chest X-rays.  From a cost standpoint, the CT angiogram could add a thousand dollar dent to your tab,” said Santa.     

Consumer Reports has culled five leading examples of “when to say whoa” in a new report available for free online at www.ConsumerReports.org and in the June issue of Consumer Reports available on newsstands today.  Some highlights:   

• EKGs and exercise stress tests for heart disease are key for people who have symptoms of heart disease or are at high risk for it. But for otherwise healthy people, the tests are not as accurate and can lead to unnecessary follow-up and treatment.  The risks: Those follow-up tests can include CT angiograms or coronary angiography; both expose you to a radiation dose equal to hundreds of chest X-rays and other potential adverse events.  Inappropriate testing can also lead to overtreatment with drugs or angioplasty and stents.  The costs:  An EKG typically costs about $50 and an exercise stress test about $200 to $300.  But subsequent interventions can add thousands to the tab.

• Imaging tests for lower-back pain may sound like a good idea but back pain usually subsides in about a month, with or without testing.  The risks:  One study projected 1,200 new cancer cases based on 2.2 million CT scans done for lower-back pain in the U.S., not to mention the age-related changes that the  tests  can  detect,  prompting  needless  worry and further testing and treatment, possibly surgery.  The costs:  An X-ray of the lower back typically ranges from about $200 to $285, an MRI from $875 to $1,225, and a CT scan from $1,080 to $1,520.

• CT scans and MRIs for headaches rarely help the patient more than taking a careful medical history and doing a neurological exam.  The risks: Brain scans can reveal things that appear worrisome that aren’t, triggering follow-up tests and prompting referrals to specialists for expensive consultations.  CT scans of the head can deliver a radiation dose that’s the equivalent of hundreds of chest X-rays in some cases.  The costs: A standard brain CT scan costs about $340, and a brain MRI about $660. Referrals to a specialist or subsequent treatment are extra, of course.

• Bone density scans for low-risk women are used routinely to screen for weak bones with a test called a DEXA scan.  But many low-risk women learn they have only mild bone loss, a condition known as osteopenia, and for them the risk of fracture is often low.  The risks:  While there is little evidence that people with osteopenia benefit from drugs, the diagnosis often leads to treatment with drugs that pose numerous risks.  The costs: a DEXA scan costs about $132.  The price for a month’s supply of generic alendronate is $38 to $70, and $125 to $148 for Fosamax, the brand-name version.  People often take the drugs for years.

• Antibiotics for sinusitis are frequently prescribed; in fact, 15 to 21 percent of all antibiotic prescriptions for adults are to treat sinusitis.  But most people don’t need the drugs because the cause is often viral and antibiotics don’t work against viruses.  The risks:  About one in four people report side effects and in rare cases, the drugs can cause anaphylactic shock. Overuse of antibiotics also encourages the growth of bacteria that can’t be controlled easily with drugs, making you more vulnerable to antibiotic-resistant infections and undermining the usefulness of antibiotics for everyone. The costs: Not all antibiotics are expensive but since doctors write so many prescriptions for them, the total cost to the health-care system is substantial—at least $31 million a year.

Consumer Reports recommends asking these questions when the above situations arise:

• Do I really need this test or procedure?

• What are the downsides?

• Are there simpler, safer options?

• What happens if I do nothing?

• How much does it cost?

About Consumer Reports
Consumer Reports is the world’s largest independent product-testing organization. Using its more than 50 labs, auto test center, and survey research center, the nonprofit rates thousands of products and services annually. Founded in 1936, Consumer Reports has over 8 million subscribers to its magazine, website and other publications.   Its advocacy division, Consumers Union, works for health reform, food and product safety, financial reform, and other consumer issues in Washington, D.C., the states, and in the marketplace.