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Douglas L. Bechard, MD
Adventist Health System

Helping Physicians and Patients Eliminate Unnecessary Tests and Procedures

Thursday, April 5th, 2012

The American Board of Internal Medicine Foundation, nine U.S. specialty medical societies, and Consumer Reports have partnered in a new initiative called Choosing Wisely™. The goal of the initiative is to help physicians, patients, and other healthcare stakeholders start thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit—and, in some instances, harm.

Each participating medical society was charged with identifying five tests or procedures commonly used in their field that should be “red flags” for further discussion. The resulting lists represent specific, evidence-based recommendations that physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each society’s five-question list provides information as to when the tests and procedures may be appropriate, as well as the methodology used in creating each list.

Some of the recommendations presented by the various medical societies include:

  • Don’t do imaging for low back pain within the first 6 weeks, unless red flags are present. (American Academy of Family Physicians)
  • Don’t routinely do diagnostic testing in patients with chronic urticaria. (American Academy of Allergy, Asthma & Immunology).
  • Don’t perform stress cardiac imaging or advanced noninvasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present. (American College of Cardiology)
  • Don’t obtain imaging studies in patients with nonspecific low back pain. (American College of Physicians)
  • Don’t do imaging for uncomplicated headache. (American College of Radiology)
  • Don’t repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals. (American Gastroenterological Association)
  • Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis. (American Society of Clinical Oncology)
  • Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms. (American Society of Nephrology)
  • Don’t perform cardiac imaging for patients who are at low risk. (American Society of Nuclear Cardiology)

The full list of partners and their lists of five questions are available at www.choosingwisely.org.

  1. American Board of Internal Medicine (ABIM) Foundation. Initiatives. Choosing Wisely. 2012. Available at: http://www.abimfoundation.org/Initiatives/Choosing-Wisely.aspx. Accessed April 5, 2012.

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