Leaders in the field of medicine are embracing the fact that we do far too many unnecessary tests and procedures that could account for a third to a half of our $3.2 trillion annual health care spending.

In the past few weeks, nine major medical groups have each come up with five commonly ordered tests in their practices that are overused. This is part of the "Choose Wisely" campaign that is led by the American Board of Internal Medicine Foundation and Consumer Reports. Here are some of the tests and recommendations that many believe are overused. Not all groups and all recommendations are listed here.

Family physicians recommend against X-rays of the lower back during the first six weeks after symptom development; antibiotics for mild-to-moderate sinus infections; a bone-density test for women under 65 or men under 70 who have no risk factors for osteoporosis; and pap tests for women under 21 or those who have had a hysterectomy.

The American College of Physicians, which represents internists, questions the need for a routine EKG if the patient is at low risk of heart disease; CT or MRI scans if the person has fainted or lost consciousness and has no neurological problems; and preoperative chest X-rays if the patient has no lung problems.

Cancer doctors recommend against the treatment of many tumors if the patient is weak and frail and there is no proven evidence that treatment will succeed. Expensive scans — including PET, CT or bone scans — should not be done in patients with early-stage breast or prostate cancer, nor should there be excessive monitoring of patients who have had curative treatment for breast cancer.

Cardiologists recommend against routine exercise stress tests if the patient is at low risk of having heart problems and against stress tests or CT scans of the heart in patients with known heart disease who are symptom-free.

Gastroenterologists recommend the lowest effective dose in the treatment of gastric reflux. If a colonoscopy screening for cancer is normal, the test should not be repeated for 10 years. If small polyps are found, the test should be repeated every five — rather than three — years.

Radiologists recommend that X-rays and CT scans should not be done in patients with uncomplicated headaches, children with suspected appendicitis, who should be evaluated with a less dangerous and cheaper ultrasound, and women with ovarian cysts that are not causing problems.

And finally, allergists recommend against a battery of routine tests to identify a cause of allergies, the use of CT scans or antibiotics for uncomplicated sinus infections, and routine extensive testing for someone with chronic hives.

According to the American Board of Internal Medicine Foundation, this is the first of a series of recommendations aimed at physicians and the general public urging that they all "choose wisely" in recommending questionable tests.

And while the evidence seems more and more compelling that less may be adequate, it is almost impossible for advocates and specialists in the field to change practice habits that have been serving them well for decades. I believe it is rare for a physician to knowingly order a test that is unnecessary. Their experience, the way they were trained and the routines they always follow make them question the validity of recommendations against tests they use frequently. After all, in every field of endeavor there are many schools of thought with conservative, middle-of-the road and aggressive positions. And there is the real fear of litigation and concerns that failure to do something will lead to a lawsuit.

Simultaneously, patients must become more involved in understanding that insisting that everything possible be done ("After all, my insurance pays for it") may not be in their best interest. I met a survivor who had a whole-body CT scan annually to make sure the cancer had not returned. While he had read that this was excessive and perhaps dangerous, learning that he was cancer free made it worth it to him. After his fifth CT scan, his risk of another cancer from radiation is high; repeat testing will not prolong his life and the cost is high, too.

Being educated will lead to greater understanding, insights into the risk and complication, better care and will perhaps even avoid anger and litigious threats that make physicians do more than they should.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at:

www.drdavidhealth.com