New AAFP Recs: Pelvic Exams, Home Glucose Checks, Blood Transfusions, and More

Arefa Cassoobhoy, MD, MPH


September 13, 2018

Hello. I'm Dr Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

The American Academy of Family Physicians (AAFP) has updated its "Choosing Wisely" list with new recommendations.

First, they no longer recommend pelvic exams in asymptomatic, nonpregnant women, unless needed for cervical cancer screening. Even for STD testing, noninvasive options, rather than endocervical culture, are often available.

Another recommendation: Don't screen for genital herpes infection in asymptomatic adults, including pregnant women. Serologic testing is unreliable, and no confirmatory test for herpes is available.

There's also guidance against screening asymptomatic males for testicular cancer, given the low incidence of disease and high treatment cure rates.

Next, they no longer endorse daily home glucose monitoring by patients with type 2 diabetes who are not on insulin. However, testing remains useful during medication dose titration and when diet and exercise routines have changed.

The final new recommendation seeks to improve the safety of blood transfusions. Give only the minimum number of red blood cell units needed to resolve anemia symptoms or to reach a safe hemoglobin level.

In the updated list, AAFP also withdrew an earlier recommendation to screen adolescents for scoliosis. You can view the entire list, including the 2018 updates, at Choosing Wisely.

Follow Dr Cassoobhoy on Twitter at @ArefaMD


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