City Health Information
November 2012 New York City Department of Health and Mental Hygiene Vol. 31(5):33-40


Using Medical Resources Wisely
  • Unnecessary medical testing and intervention increase health care costs without improving patient care.

  • In April 2012, nine medical specialty boards issued evidence-based lists of tests and interventions that could be performed less often without compromising patient care.

  • Certain preventive medicine screenings and immunizations are underused and should be a routine part of patient care.

The United States (US) health care system is the most expensive in the world, with costs of $7538 per capita in 2008 (1). Physicians make the decisions that account for 80% of health care costs, but they do not always have the most current effectiveness data (2,3). Unnecessary medical testing accounts for as much as 30% of wasted health care resources in the US (4).

Unnecessary tests can produce "abnormal" but benign findings, leading to unnecessary treatments that pose risks to patients (5). Unnecessary tests can also cause misdiagnosis, unnecessary radiation exposure, and increased patient stress (5).

Under the auspices of Choosing Wisely®, an initiative of the ABIM Foundation, 9 medical specialty boards have each recommended 5 tests or treatments that providers and patients should question, because they may not be necessary for the delivery of high-quality care (5). The initiative stems from a New England Journal of Medicine article that proposed the creation of these recommendations to reduce health care costs without harming patient care (6). The American Academy of Allergy, Asthma & Immunology (AAAAI), American Academy of Family Physicians (AAFP), American College of Cardiology (ACC), American College of Physicians (ACP), American College of Radiology (ACR), American Gastroenterological Association (AGA), American Society of Clinical Oncology (ASCO), American Society of Nephrology (ASN), and American Society of Nuclear Cardiology (ASNC) participated in the project (5).

The Choosing Wisely recommendations that can guide primary care providers in delivering high-quality, cost-effective care are included here. The tests and treatments are categorized mainly according to organ system, with similar recommendations combined. The Choosing Wisely lists, available at, also contain recommendations for specialists.

While many common tests and procedures are unnecessary, there are also simple actions that primary care providers can take to improve the health of their patients. The New York City Health Department has listed a set of quality care recommendations as part of its Take Care New York 2012 agenda aimed at improving the health of New Yorkers. For these recommendations, see Box.

Continue to MAKING DECISIONS IN PRIMARY CARE--TESTS on the next page >