Like many of you, I have relatives who illustrate both sides of the medical-cost dilemma in the United States. Some see their doctors a lot and submit to tests and procedures as an almost welcome part of their routine. Then, there's an uncle who having rarely, if ever, visited a physician - had a massive heart attack and died some years ago.

Most of us are somewhere in the middle. But it's that middle group (as well as the overusers) that physician societies across the United States are talking to with new recommendations out April 4. Nine societies representing 375,000 physicians are unveiling tests and procedures they say are overused and unnecessary.

Among those targeted are cardiac stress tests for healthy adults without cardiac symptoms, chest X-rays before outpatient surgery and antibiotics for chronic sinusitis. The nine specialty groups are each offering a top five list of tests or procedures that they say are commonly used but may be unnecessary. The lists are part of the Choosing Wisely campaign, which has its own website.

The groups acknowledge that the campaign will be hard to implement in a country where more medical tests are considered good medicine. Physicians sometimes are reluctant to say, You don't need this, Dr. Christine Cassel, president of the American Board of Internal Medicine, told the Chicago Tribune.

It's interesting that the guidelines are coming out at a time of unprecedented measurement of physician performance by healthcare purchasers and insurers. Consider the new measuring sticks for accountable care organizations, patient-centered medical homes, payment bundling, and pay-for-performance programs. Especially in the case of ACOs, physicians are being held accountable for delivering cost-effective but appropriate care.

If physicians really embrace this, it would represent a sea change in the culture of medical delivery. It could very much advance the notion of patient-centered care that observers have been talking about for several years. If the patient really knew the value of the test, he or she might also say, no thanks.

None of us want to miss out on the early detection or drug that could prevent a bigger problem. But as the nation continues to argue about how to support our expensive healthcare system, at least some people are going to try for a little less.

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