U of T Researcher Uncovers Staggering Overuse of Medical Care

A new report co-authored by a University of Toronto researcher examined a handful of the most common medical treatments in Canada and found up to 30 per cent were unnecessary.

The report, titled “Unnecessary Care in Canada,” was published April 6 by Choosing Wisely Canada and the Canadian Institute of Health Information (CIHI). This was the first national study to look at unnecessary use of medical care in Canada, says its co-author, Professor Wendy Levinson of the Department of Medicine.

“Overuse is baked into our health system – nobody questions when you order an unnecessary test. They only question it when a test wasn’t ordered and something was missed,” she says. “But more is not always better in health care.”

Levinson, a physician-researcher, founded Choosing Wisely Canada, a movement that combats overtesting and overtreating by encouraging doctors and patients to discuss the risks, in addition to the benefits, of medical procedures and treatments.

Choosing Wisely maintains a growing list of procedures that patients may want to reconsider because the risks generally outweigh the benefits. For example, medications always have side effects. Tests like CT scans increase a person’s lifetime risk of cancer due to their radiation, and false positives lead to more testing. Biopsies are invasive and can lead to infections and other complications. And the stress of unnecessary medical testing can be damaging to quality of life and health.

For the current study, Levinson chose eight common medical tests and treatments from Choosing Wisely’s list, and examined CIHI data from one province per procedure to determine how many were unnecessary. She found the following recommendations were not followed up to 30 per cent of the time:

• Don’t do imaging for lower back pain without red flags.
• Don’t use low-dose quetiapine (an atypical anti-psychotic) to treat kids for insomnia unless other approaches have failed.
• Don’t use benzodiazepines (a common sedative) treat agitation, insomnia or delirium in seniors unless other approaches have failed.
• If a woman age 40 to 49 is at average risk for breast cancer, don’t give her a mammogram until she is 50.
• Before surgery, don’t routinely perform pre-operative testing, such as chest x-rays, EKGs or other heart scans on low-risk patients.
• In the Emergency Room, don’t do CT scans for minor head injuries, or any kind of scans for minor head trauma, unless red flags are present.
• Don’t give CT scans to hospitalized patients for delirium without other risk factors.
• Don’t do red blood cell transfusions for ordinary surgeries such as knee and hip replacements.

While the study examined a small numberof medical interventions, Levinson said it still represented about a million unnecessary tests and treatments.

Doctors often believe patients want them to take action, she says, and patients usually assume if a doctor offers to order a test, there’s nothing more to talk about. Taking time to discuss the matter could make a massive difference, Levinson believes.

“Choosing Wisely is about the conversation. We want people to understand they can talk about this,” she says. And no matter how busy the doctor is, discussing the necessity of a medical intervention only takes about one minute longer, she adds.

In talking to physicians about a test or treatment, Levinson recommends asking four questions:

• Do I really need this test or treatment?
• What are the downsides?
• Are there other options?
• What if I do nothing?