Are you 'Choosing Wisely'? 90 more things doctors shouldn't do

17 medical societies participate in latest round of recommendations

The American Board of Internal Medicine (ABIM) Foundation on Thursday added 90 tests and treatments to the "Choosing Wisely" campaign's list of unnecessary or overused procedures.

The list is the second to be released by the campaign, which launched in April 2012 with 45 recommendations from nine leading medical groups. The effort has expanded to 17 medical societies, each of which identified five tests or procedures that are common practice but whose use should be questioned.

Altogether, the campaign now includes more than 130 avoidable tests and procedures from 26 medical groups. The recommendations includes procedures and tests in geriatrics, ophthalmology, maternal health and other categories.

Daniel Wolfson, executive vice president of the ABIM Foundation, say all the recommendations send the message that "sometimes less is better." He adds, "Sometimes, it's easier [for a physician] to just order the test rather than to explain to the patient why the test is not necessary," he says, adding that now, "[p]eople are looking at quality and safety and real outcomes in different ways."

The latest round of recommendations includes:

  • Wait six weeks to do imaging for lower-back pain, unless certain warning assigns are present;
  • Avoid ordering annual electrocardiograms for low-risk patients without symptoms;
  • Do not prescribe cold or cough medications for children under age four;
  • Feeding tubes should not be used in patients with advanced dementia;
  • Do not treat women whose Pap test for cervical cancer finds dysplasia, unless the abnormalities persist for two years; and
  • Women under age 21 and those who have had a hysterectomy for anything but cancer should not get Pap tests, while other women between ages 30 and 65 should be screened every three years.

According to Reuters, the groups did not consider costs when creating their lists. However, the recommendations could save billions of dollars annually, according to John Santa, director of Consumer Reports' Health Ratings Center, a campaign partner. One medical group with 300,000 patients would reduce its billings by $1 million annually if it followed recommendations to reduce unnecessary EKGs and bone density scans, Santa noted.

Several business groups have signed on to Choosing Wisely in the hopes of reducing health care costs. For example, the National Business Council on Health—with 7,000 employer members—and the National Business Group on Health—representing Fortune 500 companies and other large employers—are distributing the campaign's educational materials to its members.

The ABIM Foundation noted that three specialty medical societies plan to update their lists later this year. Further, another nine groups—including the American Academy of Orthopaedic Surgeons—will release recommendations in 2013 (Lee, Modern Healthcare, 2/21 [subscription required]; Pittman, MedPage Today, 2/21; Somashekhar, Washington Post, 2/21; Begley, Reuters, 2/21; Wang, Wall Street Journal, 2/20).

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