https://www.nytimes.com/2018/09/10/upshot/its-hard-for-doctors-to-unlearn-things-thats-costly-for-all-of-us.html
http://www.choosingwisely.org/clinician-lists/
Aaron E. Carroll writes about medical procedures that have been shown to be useless or worse, but are still commonly done. Useless medical procedures obviously add cost, and may add to medical risks to the patient.
Must take this objectively. I have a sports medicine practice that is highly pediatric to collegiate. Now that this article surfaced I will have parents not wanting me to take foot /ankle x-rays on Monday. The reality is in my world is that I see stress fractures and or growth plate injuries that go undiagnosed on a regular basis. The things we see is when the pediatrician or general physician just order x-rays /mri at a drop of a hat. On TV what happens when a sports figure gets injured? They go to the locker room for x-rays and mri… People think this is the norm and it’s not. Then there’s the medical /legal aspect but I digress.
Over- or underutilization of a certain technology is different than continuing to use procedures that have been proven ineffective.
Sorry, paywall makes it hard to view more than 1st paragraph or so.
I have consistently refused to get annual chest X-rays my former internist orders. When I ask why he orders them, I’ve never gotten a good reason and have read that annual chest X-rays are NOT recommended.
I switched gyns when my doctor refused to discuss pros and cons if continuing to take BC pills, especially as I was over 40 years old. The new gyn is much better at discussing pros and cons and having real discussions.
Our insurer required pre-auths of CT scans now, which allows it to be gatekeeper but does reduce radiation exposure some.
Not really pertinent, but it’s driving me nuts to read an account of research studies in which the treatment groups are repeatedly referred to as “control” groups. Wouldn’t it make more sense to use some term other than “control” to describe a treatment protocol that is being studied?
I was really hoping to see episiotomy listed there as a “don’t do.” I know in some hospitals it’s still a regular procedure, despite evidence that it’s very rarely medically necessary.
If a given treatment is the norm for a particular situation, wouldn’t it be the control condition, and a different treatment or non-treatment be the experimental condition?
This unlearning is a HUGE problem in reproductive health. I cannot tell you the number of women I know whose doctors told them that they couldn’t get an IUD because they haven’t had kids (not true).
Every time I go to my rheumatologist, he gives me a new ANA test. I don’t know why- ANA doesn’t generally change. It isn’t a marker of disease activity.
In preparation for pregnancy, I had to go through yet another round of antibody testing to prove that I had a specific antibody that makes pregnancy risky. I’ve tested positive for it 3 times and it isn’t one that goes away.
I’ve had literally hundreds of vials of blood drawn in the last several years and the vast majority of them were completely unnecessary.
As a T2 diabetic who is all too familiar with the “standards” promulgated by the ADA, the nutritional establishment, et al, I would venture to guess that the problem with tight control arises largely from incompetence in designing and administering the protocol. For example, instead of starting with diet, I bet they administer drugs that increase the number of dangerous lows.
There is a reason it is called the practice of medicine. What we learn in medical school and read in currents journals changes, sometimes like a pendulum. So many variables to consider. As a physician patient I was dropped from a practice because they were overtesting- I trust heart lab testing frequency to the American College of Cardiology. Gave up on the twice a year lipid panel with second doctor, third one practical (like cardiologist H).
Lawyers also raise costs because so much is done for fear of missing something and getting sued.
There are generally no hard and fast rules. Being an early adapter can backfire when later data disproves the trend. The older one gets the more philosophical one needs to be regarding so many things, including medical care. There never will be the perfect system, only different ways in different times.
Try Incognito Window in Chrome (or Private Browsing or whatever it’s called in other browsers) 
I did try private browser in IPhone but it still wants me to have full paid subscription. Sometimes for other articles I have been successful when using private browser or similar.
Drat!
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Thanks. I will try.