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Five Things Physicians and Patients Should Question

Specialty societies issue lists of unnecessary tests and procedures (Feb. 21)

The Choosing Wisely initiative — established by the ABIM Foundation — is designed to help physicians and patients engage in conversations to reduce the overuse of tests and procedures, and to support physicians’ efforts to help patients make effective care choices.

As part of this initiative, leading medical specialty societies, along with Consumer Reports, have identified tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” are intended to encourage discussions about the need for medical tests and procedures that may be unnecessary and that may even cause harm.

More than 35 specialty societies have joined the campaign, and 17 of these groups unveiled new lists on February 21.

Each list presents specific, evidence-based recommendations that physicians and patients should discuss to help make decisions about the most appropriate care based on their individual situations.

For example, the Society of Hospital Medicine (SHM) has issued the following recommendations for adult patients:

  • Don’t place, or leave in place, urinary catheters for incontinence for convenience or for monitoring output in non-critically ill patients (acceptable indications: critical illness, obstruction, hospice, perioperatively for less than 2 days for urologic procedures; use weights instead to monitor diuresis).
  • Don’t prescribe medications for stress ulcer prophylaxis to medical inpatients unless they are at high risk for gastrointestinal complications.
  • Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure, or stroke.
  • Don’t order continuous telemetry monitoring outside of the intensive care unit without using a protocol that governs continuation.
  • Don’t perform repetitive complete blood cell (CBC) and chemistry testing in the presence of clinical and laboratory stability.

Moreover, the SHM suggests the following precautions for pediatric patients:

  • Don’t order chest radiographs in children with uncomplicated asthma or bronchiolitis.
  • Don’t routinely use bronchodilators in children with bronchiolitis.
  • Don’t use systemic corticosteroids in children under 2 years of age with an uncomplicated lower respiratory tract infection.
  • Don’t routinely treat gastroesophageal reflux in infants with acid-suppression therapy.
  • Don’t use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen.

“Twenty-five of the nation’s leading medical specialty societies have now spoken up and shown leadership by identifying what tests and treatments are common to their profession, but not always beneficial,” said Christine K. Cassel, MD, president and CEO of the ABIM Foundation. “Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better. Through these lists of tests and procedures, we hope to encourage conversations between physicians and patients about what care they truly need.”

Sources: ABIM Foundation; February 21, 2013; and Choosing Wisely; February 21, 2013.

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