Common Clinical Situations Physicians and Patients Should Discuss

Many screening and diagnostic tests often offer little benefit and sometimes cause harm

PHILADELPHIA, January 17, 2012 -- Common clinical scenarios can result in better health outcomes if physicians and patients discuss the benefits and harms of screening and diagnostics tests that are often unnecessary or might cause harm, according to a paper published today in Annals of Internal Medicine.

"Appropriate Use of Screening and Diagnostic Tests to Foster High Value, Cost-Conscious Care" is an opinion article published by a group of physicians from the American College of Physicians (ACP). The authors reviewed the evidence and identified 37 common clinical situations relevant to internal medicine in which screening and diagnostic tests are often used in ways that provide little or no benefit to patients.

"We hope to promote thoughtful discussions among physicians, patients, and other stakeholders about common clinical scenarios in which there are opportunities to improve the quality of care for the benefit of patients," said co-author Steven Weinberger, MD, FACP, executive vice president and CEO of ACP. "Wasteful and duplicative practices that do not improve patient health -- and might even cause harm -- are unfortunately all too common and an important component of escalating, unsustainable health care costs."

Physicians, other health care professionals, and members of the public can complete a brief web survey on to indicate whether they agree that each of the items represents low value care. Survey respondents can also indicate clinical situations that they would add to the list


In an accompanying editorial, Christine Laine, MD, FACP, editor of Annals of Internal Medicine, says that the time is right to discuss how to achieve health care savings and improve the quality of care through more thoughtful use of an ever increasing array of tests.

"Physicians, whether they agree or disagree with the ACP workgroup's or other groups' lists of overused interventions, can improve the value of testing by asking themselves a few common sense questions before ordering any test," Dr. Laine writes. "Too often, we order tests without stopping to think about how (if at all) the result will help the patient. A few moments of reflection before test ordering could reduce the human and financial costs of low value testing."

By some estimates from the Congressional Budget Office, up to 30 percent of health care costs are spent on care that is duplicative or unnecessary and may not improve people's health.

ACP launched a High Value, Cost-Conscious Care initiative in 2010 to help physicians provide the best possible care to their patients while simultaneously reducing unnecessary health care costs. ACP defines high value, cost-conscious care as the delivery of services providing benefits that make their harms and costs worthwhile.

Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests or treatments have low value because they do not provide enough benefit to justify even their low costs and might even be harmful.

"Like ACP's Best Practice Advice paper for diagnostic imaging for low back pain, we plan to continue to produce evidence-based recommendations and educate clinicians and patients about how to pursue care together that improves health, avoids harms, and eliminates wasteful practices," Dr. Weinberger said.

About the American College of Physicians

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 132,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.