The overuse of certain medical procedures is a common problem in healthcare. The Journal of the American Medical Association, Internal Medicine produces an annual review of procedures, services, and tests that are often unnecessary, expensive, and may even cause harm to the patient. Here are the highlights from the 2018 and 2019 reports:
- Electrocardiograms are routinely performed on low-risk patients
- Lipid monitoring rarely affects care
- Overdiagnosis of cancer caused anxiety and criticism about not seeking treatment
- Calcium and vitamin D supplementation does not reduce hip fracture
- Pregabalin does not improve symptoms of sciatica but frequently has adverse effects
- Antipsychotic medications increased the severity of delirium in patients receiving hospice care and were associated with an increased risk of death
- Robotic-assisted radical nephrectomy (kidney removal) was without benefits due to being slower and more costly than laparoscopic surgery
- One-third of patients who received a diagnosis of asthma had no evidence of asthma
- Overused testing included:
- High-sensitivity troponin testing to detect heart injury often yielded false-positive results
- The level of procalcitonin in blood does not affect antibiotic duration in patients with lower respiratory tract infection
- Incidentally finding tumors occurs in 22% to 38% of common magnetic resonance imaging or computed tomography studies
- Nine percent of women dying of stage IV cancer are still screened with mammography
- Computed tomography lung cancer screening has higher rates of harm for patients at lower risk
- Urgent care clinics commonly over-prescribe antibiotics
- Treatment of subclinical hypothyroidism had no effect on clinical outcomes
- Using opioids for chronic non-cancer pain may have no clinically significant benefit
- Using medication to prevent stress ulcers for intensive care unit patients had little impact on survival
- Supplemental oxygen for patients with normal oxygen levels can be harmful
- On the positive side, restructuring the electronic health record was able to reduce unnecessary testing
Be sure to stay informed about overused procedures at our evidence-based medicine page.
