No need for a checkup—and 14 more things physicians shouldn't recommend

ABIM campaign continues as three more specialty groups weigh in

Medical groups this week released a slew of new recommendations as part of the American Board of Internal Medicine's (ABIM) "Choosing Wisely" campaign—designed to convince doctors to avoid unnecessary procedures.

Medical groups add their 'wise' recommendations

The Society of General Internal Medicine (SGIM) released a statement with five common procedures that internists should avoid, including:
  • Performing routine general health check-ups for asymptomatic adult patients;
  • Daily home glucose testing in patients with Type II diabetes not using insulin;
  • Recommending cancer screening in patients with a life expectancy of less than 10 years;
  • Performing routine pre-operative testing before low-risk surgical procedures; and
  • Placing or leaving in place peripherally inserted central catheters for patient or provider convenience.

"We believe that general internists have an important role to play in helping patients make informed decisions about tests and procedures that may otherwise be used too often," SGIM President Eric Bass said.

The American Academy of Orthopaedic Surgeons (AAOS) joined the conversation Thursday, by releasing a list of five common procedures orthopedic surgeons order that may be unnecessary. AAOS recommends orthopedic surgeons avoid:

  • Performing routine post-operative deep vein thrombosis ultrasonography screening in elective hip or knee arthroplasty patients;
  • Using glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee;
  • Using needle lavage for long-term relief when treating patients with symptomatic osteoarthritis of the knee;
  • Using post-operative splinting of the wrist after carpal tunnel; and
  • Using lateral wedge insoles to treat patients with symptomatic medial compartment knee osteoarthritis.

The AAOS recommendations will "shape patient-physician dialogue, which as we all know is the cornerstone of optimal care," AAOS President Joshua Jacobs said, adding that "[i]dentifying tests, procedures or treatments that show little to no value not only helps our patients by preventing unnecessary care, but will end up saving health care dollars."

The American College of Surgeons (ACOS) added five recommendations for surgeons, including avoiding:

  • Performing 'whole-body' diagnostic CT scans in patients with minor or single system trauma;
  • Performing CT scans to evaluate suspected appendicitis in children before completing an ultrasound;
  • Screening for colorectal cancer on asymptomatic patients with a life expectancy of less than 10 years and/or no family or personal history of the cancer;
  • Performing axillary lymph node dissection for patients with stage I and II breast cancer without first attempting sentinel node biopsy; and
  • Admitting or performing preoperative chest x-rays for ambulatory patients with unremarkable medical histories and physical exams.

ABIM president and CEO Richard Baron said that the recommendations will reduce waste and overuse in the U.S. health care system and will help "physicians and patients across the country engage in conversations about what care they need."

About 30 specialty societies are expected to make similar Choosing Wisely statements during the coming months, Medscape Today reports (Hand, Medscape Today, 9/11; Hand, Medscape Today, 9/12).

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