The Dos and Don’ts of Health Care: Choosing Wisely

Choosing Wisely Recommendations

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On April 4th, the American Board of Internal Medicine (ABIM) Foundation, in collaboration with Consumer Reports, issued a call to arms for health care providers to limit the use of 45 common medical tests and procedures. Requesting nine of our nation’s most important medical societies to weigh in, the ABIM Foundation and Consumer Reports released nine lists of “Things Physicians and Patients Should Question” under the rubric Choosing Wisely.

What the Recommendations Mean for You

Choosing Wisely is an educational initiative, aimed at patients and health care providers, that encourages frank discussions between patients and providers about what kind of care is truly medically necessary.

The goal is a worthy one: for patients and their health care providers to make informed health care decisions. However, there’s nothing new in these recommendations. Providers who have stayed on top of medical developments have been following these guidelines for several years. Still, it’s comforting to know that there is no disagreement among the experts–there is a great deal of overlap among the various societal recommendations.

Malcolm Thaler, a doctor at One Medical Group, said, “The public and the medical establishment have reacted with predictable dissension about several–but not most–of these recommendations, with the more strident among the critics crying out that this is the beginning of health care rationing.”

Thaler continued, “From our standpoint, there is no need for hysteria or even concern. These new guidelines are based on medical fact and medical evidence, and there is not a controversial one in the bunch. It’s what all responsible medical practitioners should be doing.”

A Brief Look The Recommendations

Each of the nine consulting societies contributed five recommendations. Here’s a small sampling from a few of those agencies:

  • Don’t obtain imaging studies in patients with non-specific low back pain.
  • Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.
  • Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.
  • Don’t repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
  • In the evaluation of simple syncope (fainting spell) and a normal neurological examination, don’t obtain brain imaging studies (CT or MRI).
  • Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.
  • Don’t do imaging for uncomplicated headache.

And here are the full lists of recommendations from each of the nine participating medical specialty boards:
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology

Final Thoughts on Choosing Wisely

As a primary care practice, we encourage our patients to take a proactive approach to their health. That includes eating well, exercising, managing stress, and paying regular visits to your health care provider–especially if you have symptoms that you shouldn’t be ignoring.

Sometimes testing can turn people into patients unnecessarily. In a worst-case scenario, overtesting can lead to unnecessary treatment, which may then lead to potential complications related to treatment and/or diagnosis. Some of these complications include: increased anxiety over health “issues”; side effects from drug treatments; and complications stemming from surgery.

In sum, sometimes testing is helpful, and sometimes it’s not. As a practice, we stay on top of the latest data regarding the risks and benefits of certain types of testing, and we help our patients select the tests that are best for them–which, in the absence of any symptoms, might be none at all.

So while there isn’t anything new to our providers in the Choosing Wisely recommendations, we fully support the practice of patients acting as their own health care advocates and being informed consumers of health care.

Editor’s Note: We’ve talked about the debate over testing before. Don’t miss these related posts: 

Prostate Cancer Screening: Is It Worth the Risk?
The Rap on NOT Getting a Yearly Pap
Medical Check Up: Which Screenings Do You Need?

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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