I am torn on this. As a family doctor who also thinks himself as a steward of the healthcare system, I love the idea of a “campaign to fight unneeded tests“. The first 45 recommendations came out last April. There are now a total of 135 with the ones below recently added. My question is simple. Will this hold up in a court of law or with the state boards of medicine if a patient decide to sue or report the doctor? Don’t be so quick to say yes.
18 interventions primary care doctors should question or avoid
The medical specialty societies participating in the Choosing Wisely campaign have identified 90 more examples of potentially inappropriate care. Among them are items especially relevant to primary care physicians and their patients, which say:
- Don’t schedule elective, nonmedically indicated inductions of labor or cesarean deliveries before 39 weeks’ gestational age.
- Avoid elective, nonmedically indicated inductions of labor between 39 weeks and 41 weeks unless the cervix is deemed favorable.
- Don’t screen for carotid artery stenosis in asymptomatic adult patients.
- Don’t screen women older than 65 for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
- Don’t screen women younger than 30 for cervical cancer with human papillomavirus testing, alone or in combination with cytology.
- Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
- Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children younger than 4.
- CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation and Pediatric Emergency Care Applied Research Network criteria should be used to determine whether imaging is indicated.
- Neuroimaging is not necessary in a child with simple febrile seizure.
- Don’t perform routine annual Pap tests in women 30 to 65.
- Don’t treat patients who have mild dysplasia of less than two years in duration.
- Don’t screen for ovarian cancer in asymptomatic women at average risk.
- CT scans are not necessary in the routine evaluation of abdominal pain.
- Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.
- Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
- Avoid using medications to achieve hemoglobin A1c of less than 7.5% in most adults 65 and older; moderate control is generally better.
- Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
- Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.
Sources: Choosing Wisely lists of five things physicians and patients should question by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and American Geriatrics Society