NLM Director’s Comments Transcript
ABIM: Avoid these Medical Tests – 05/06/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

The American Board of Internal Medicine Foundation (ABIM) – in conjunction with 25 medical specialist groups — recently urged patients to avoid an array of common medical tests.
ABIM notes patients should bypass some widely available medical tests, procedures, or therapies that research suggests are either unnecessary or harmful. ABIM’s recent recommendations are part of an ongoing effort to provide patients with helpful clinical information, called ‘Choosing Wisely’.
ABIM’s chief executive officer said in a press release (and we quote): ‘Twenty-five of the nation’s leading medical specialty societies have spoken up and show leadership by identifying what tests and treatments are common to their profession, but not always beneficial’ (end of quote). ABIM’s press release notes more than 725,000 physicians are members of the 25 participating medical specialty groups.
ABIM’s latest recommendations include tests to avoid across many medical fields including urology, neurology, obstetrics, and rheumatology. ABIM’s executive vice president told the Washington Post the project is intended to let patients know that in medicine (and we quote): ‘sometimes less is better’ (end of quote).
A few of ABIM’s 90 current, evidence-based recommendations, which are reviewed by the relevant medical specialty group, are:

Patients with advanced dementia should avoid being fed with a feeding tube. ABIM’s recommendation (from the American Geriatrics Society, and the American Academy of Hospice and Palliative Medicine) notes oral feeding provides a better option.
Children with minor headaches should avoid a CT scan. ABIM’s recommendation (from the American Academy of Pediatrics) notes CT scans are associated with radiation exposure that can enhance the risk of future cancers. The recommendation adds CT scans may be appropriate after careful clinical observation.
Adults over age 65 with type 2 diabetes should avoid medicines to achieve a tight control of their blood sugar levels. ABIM’s recommendation (from the American Geriatrics Society) notes using medications to tightly control blood sugar levels (among seniors with type 2 diabetes) is associated with higher mortality rates.
Persons with recurrent headaches should avoid electroencephalography (EEG) tests. The recommendation (from the American Academy of Neurology) notes EEGs do not provide clinical diagnostic advantages, do not improve outcomes, and increase medical costs.

ABIM’s press release notes the participating medical specialty groups (and we quote): ‘believe the recommendations can make a significant impact on patient care, safety, and quality’ (end of quote). The complete recommendations are listed at choosingwisely.org.
On the day the recent recommendations were released, the director of Consumer Reports’ Health Ratings Center (which is a partner in the ongoing Choosing Wisely campaign) told Reuters the cost savings — by not doing the tests ABIM recommends against — could be billions of dollars annually.
Overall, ABIM’s recommendations supplement the growing information patients can use to speak to a medical professional about the treatment of specific diseases and conditions. MedlinePlus.gov’s talking with your doctor health topic page emphasizes preparation before seeing a health care provider helps obtain information and improves clinical outcomes.
An insightful website from the Agency for Healthcare Research and Quality (AHRQ) explains why good health depends on communicating well with your physician. In contrast to ABIM’s specific recommendations, AHRQ’s website focuses more broadly on asking questions about medical tests and clinical procedures. The AHRQ website is available in the ‘overviews’ section of MedlinePlus.gov’s talking with your doctor health topic page.
An interactive, narrated tutorial provides additional tips about doctor/patient communication and is available within the ‘tutorials’ section of MedlinePlus.gov’s talking with your doctor health topic page.
MedlinePlus.gov’s talking with your doctor health topic page also contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the talking with your doctor health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s talking with your doctor health topic page, just type ‘talking with your doctor’ in the search box at the top of MedlinePlus.gov’s home page. Then, click on ‘talking with your doctor (National Library of Medicine).’
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