Choosing Wisely

ChoosingwiselyAs part of the ABIM Foundation’s Choosing Wisely campaign, the American Academy of Family Physicians today released its third list of common tests and procedures that research suggests may be duplicative or unnecessary.

Launched in April 2012, Choosing Wisely is a national effort that has brought together more than 50 medical specialty societies to identify common tests, procedures and medications that may not be necessary or beneficial to patients.

“As primary care specialists, family physicians are the frontline providers for millions of Americans – so we have a duty to make sure our members are doing everything they can to provide the right care, for the right patient, at the right time,” said Reid Blackwelder, MD, FAAFP, president of the AAFP. “In today’s healthcare environment, it is increasingly important to ensure physicians deliver the most effective, beneficial care possible. These Choosing Wisely lists can help our members identify treatments and procedures that may be wasteful.”

The AAFP’s new Choosing Wisely items are as follows:

Do not prescribe antibiotics for otitis media in children aged 2-12 years with non-severe symptoms where the observation option is reasonable.

The “observation option” refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief. The decision to observe or treat is based on the child’s age, diagnostic certainty, and illness severity. To observe a child without initial antibacterial therapy, it is important that the parent or caregiver has a ready means of communicating with the clinician. There also must be a system in place that permits reevaluation of the child.

Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.

The risks associated with radiation (plus the discomfort and expense of the procedure) outweigh the risk of delaying the detection of the few children with correctable genitourinary abnormalities until their second UTI.

Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.

Do not screen adolescents for scoliosis.

There is no good evidence that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening. The potential harms of screening and treating adolescents include unnecessary follow up visits and evaluations due to false positive test results and psychological adverse effects.

Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications.

Hormonal contraceptives are safe, effective, and well tolerated for most women. Data do not support the necessity of performing a pelvic or breast examination to prescribe oral contraceptive medications. Hormonal contraception can be safely provided on the basis of medical history and blood pressure measurement.

The previous AAFP Choosing Wisely lists are on the Choosing Wisely site

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