Indian cardiologists plan campaign to reduce unnecessary investigations

Some of India’s best known cardiologists are planning an initiative called the Society for Less Investigative Medicine to help reduce the number of unnecessary investigations that patients undergo, beginning with cardiology.

Balram Bhargava, professor of cardiology at the All India Institute of Medical Sciences in New Delhi and executive director at the Stanford-India Biodesign Centre, is helping to spearhead the effort. He told The BMJ that modern medicine was practised with an increasing emphasis on investigative tests and check-ups, many of which were unnecessary. He added that many patients today approached doctors asking for tests rather than allowing what Bhargava believed was the doctor’s prerogative to not order a test. In some instances a patient may require just a cholesterol test, he said—but the pathology laboratory would conduct a raft of tests that were not necessary.

On other occasions, patients did not see the need to meet their doctor personally but sent in their test results with a relative, thus denying the doctor the opportunity to examine the patient directly and make their own clinical judgment on the case, he added.

Bhargava also raised questions about the emphasis on annual health checks, such as the yearly exercise tests that government class I officers undergo—which, if clear, can lead some officers to presume that they can continue with bad habits and unhealthy lifestyle choices. He said that it was more important for people to monitor risk factors such as smoking, blood pressure, and weight.

However, he stressed that the Society for Less Investigative Medicine was not aiming to “police” medicine and that he was not against check-ups. He highlighted screening for oral cancer and cervical cancer as two examples of screening tests that had had a positive effect on health.

Bhargava said that the society planned to increase awareness about unnecessary medical tests and was considering launching a regular column in a national newspaper or a national debate on television. He also said that India needed to develop guidelines, such as those of the United Kingdom’s National Institute for Health and Care Excellence, to provide evidence based recommendations on a wide range of subjects. Such guidelines would encourage people to get the right kind of care instead of immediately visiting a specialist or getting unnecessary tests, he said.