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JAMA Patient Page
November 26, 2014

Talking to Your Doctor About Tests, Treatments, and Their Costs

JAMA. 2014;312(20):2178. doi:10.1001/jama.2014.3693

Health care spending in the United States has been increasing rapidly.

In 2012 alone, the United States spent $2.87 trillion on health care. This level of spending is not sustainable for the future of US health care. As a result, doctors are now trying to more carefully weigh the costs, risks, and benefits of each test or treatment before giving it to patients. They want to be sure that money is spent on interventions that are truly helpful and do not end up causing more harm than good. For instance, taking too many antibiotics can cause people to become resistant to them, and too many computed tomography scans can increase the risk of cancer.

Choosing Wisely

In 2011,the American Board of Internal Medicine Foundation began a campaign called Choosing Wisely. The campaign aims to guide doctors and patients in making the best choices when faced with the ever-growing number of procedures, tests, and treatments available in medicine.

Choosing Wisely publishes “top 5” lists of tests, procedures, and treatments within various fields of medicine that experts believe should be questioned. Many items on these lists were routinely used in the past, but more recent evidence and clinical guidelines now bring their benefit into question. Physicians may have performed procedures as a precaution or to comply with patient requests—some of them driven by incorrect information.

Choosing Wisely recommends that both doctors and patients always stop and ask whether these “top 5” tests or treatments are truly necessary. The lists are not meant to be hard and fast rules. Rather, they are meant to start a conversation between doctors and patients.

Each “top 5” list is developed by a careful review of the evidence of effectiveness, cost, value, relevance, and potential to change practice. More than 50 subspecialties of medicine are included so far, and the collection continues to grow every year. Many specialties include additional information, making the Choosing Wisely website an in-depth source of scientifically accurate and up-to-date information. Consumer Reports has turned these physician-directed lists into simplified versions specifically for patients. For example, in family medicine, one Choosing Wisely recommendation is “Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.” The Consumer Reports version is “Don’t rush to antibiotics.”

Less Is More

In May 2012, JAMA Internal Medicine launched the Less Is More series. With the amount of health care waste estimated at $1 trillion or more, the series aims to provide information for doctors about how to avoid wasteful health care. For example, the series challenges the common belief among both patients and doctors that technology is always good and that newer technology is always better than old.

The bottom line is that you should not hesitate to talk to your doctor about the cost of tests and treatments and whether they are truly necessary to improve your health.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: American Board of Internal Medicine Foundation, Institute of Medicine, Consumer Reports

Topic: Health Care Delivery

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