Neurologist looks beyond existing Choosing Wisely campaign recommendations

Aside from wasting money and time, too many tests can result in false positives and inappropriate treatment. The Choosing Wisely campaign was thus created to limit wasteful or unnecessary medical tests, treatments and procedures, but one group is looking to expand some of the recommendations already in place.

Specifically, Brian Callaghan, MD, MS, neurologist at the University of Michigan Health System, and colleagues are looking beyond the American Academy of Neurology's (AAN) initial list of five tests and treatments that are performed more than necessary, according to a statement.

Callaghan's neurology group identified 74 more items to "look into" based on their mention within recommendations that addressed neurological care, such as those from the American Academy of Sleep Medicine and the American Academy of Neurological Surgeons. Many were duplicates, which might indicate a consensus of areas to focus on.

"The two biggest areas that might be done more than they should are imaging for low back pain and imaging for headaches," Callaghan said. "It's a big problem and it costs a lot of money-we're talking a billion dollars a year on just headache imaging."

The other tests/treatments appearing most often in recommendations assessed by Callaghan and team were opioids, or pain medications. The diseases/symptoms that appeared most often in recommendations in addition to back pain and headache were dementia/delirium, concussion and stroke.

"Ordering an MRI for a headache is very quick, and it actually takes longer to describe to the patient why that's not the best route," Callaghan said. "These guidelines are meant for physicians and patients both, to trigger a conversation."

Callaghan's team also came up with areas that need more recommendations, including movement disorders, neuromuscular disease, epilepsy and multiple sclerosis.