'Choosing Wisely' Targets 90 More Dubious Tests, Therapies

February 21, 2013

Seventeen medical societies today released a list of almost 90 common but often unnecessary tests and procedures, many of them ordered for a peculiar kind of patient — the one without symptoms.

No fewer than 12 of the guidelines issued as part of the "Choosing Wisely" campaign of the American Board of Internal Medicine Foundation caution physicians that asymptomatic patients probably do not need a given treatment. A few examples follow, along with the society that recommended them:

  • Don't screen for carotid artery stenosis in asymptomatic adult patients (American Academy of Family Physicians).

  • Don't automatically use computed tomography scans to evaluate children's minor head injuries (American Academy of Pediatrics).

  • When prescribing medication for most people aged 65 years and older who have type 2 diabetes, avoid attempting to achieve tight glycemic control (American Geriatrics Society).

  • Don't routinely order imaging tests for patients without symptoms or signs of significant eye disease (American Academy of Ophthalmology).

  • Don't screen for ovarian cancer in asymptomatic women at average risk (American College of Obstetricians and Gynecologists).

  • Avoid using stress echocardiograms on asymptomatic patients who meet "low-risk" scoring criteria for coronary disease (American Society of Echocardiography).

American Board of Internal Medicine President Christine Cassel, MD, said such rules of thumb seek to change the mindset in physicians and patients alike that "more is better," which leads to wasteful spending and sometimes puts the patient at risk.

"What you're talking about is a culture change," Dr. Cassel told Medscape Medical News.

In April 2012, the Choosing Wisely campaign released 5 guidelines apiece from 9 medical specialties. One of those societies, the American Academy of Family Physicians, has released an additional 5 guidelines in this year's batch. The Society of Hospital Medicine, making its Choosing Wisely debut in 2013, also issued 5 guidelines for adult inpatient care and another 5 for pediatric inpatient care.

The 2013 guidelines from all 17 societies total 90 guidelines, but one appears in the list both from the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists. That guideline cautions physicians not to schedule elective, nonmedically indicated induction of labor or cesarean deliveries before 39 weeks and zero days of gestational age.

As it did last year, the watchdog organization Consumer Reports is working with other consumer-oriented groups such as AARP, the Leapfrog Group, and the National Partnership for Women & Families, as well as Wikipedia, to spread the Choosing Wisely guidelines to patients. This public outreach seeks to educate Americans that not every test and procedure is appropriate for a particular condition, said William Zoghbi, MD, president of the American College of Cardiology, which released its list of 5 last year.

"Sometimes patients request a treatment they don't need," Dr. Zoghbi told Medscape Medical News. "It takes much longer to dissuade a patient from asking for test than actually ordering the test."

More information on Choosing Wisely is available on the initiative's Web site.