Encouraging conversations between physicians and patients to improve care.
The American Academy of Family Physicians (AAFP) remains committed to supporting the Choosing Wisely®(www.choosingwisely.org) campaign with the goal of ensuring high-quality, cost-effective care to patients. The AAFP has identified 15 tests and procedures(5 page PDF) that both doctors and patients should carefully consider and openly discuss before incorporating them into a treatment plan.
About Choosing Wisely®
The Choosing Wisely®(www.choosingwisely.org) campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation(www.abimfoundation.org) to improve health care quality. More than 50 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.
Watch Michael LeFevre, MD, MSPH, as he talks about the importance of the Choosing Wisely initiative to ensure high-quality. Dr. LeFevre is Future of Family Medicine Professor and Vice Chair at the Department of Family and Community Medicine at the University of Missouri, Columbia.
To help reduce unnecessary or harmful treatments and tests, the AAFP recommends that family physicians have conversations with patients regarding the safety and efficacy of:
Antibiotics for Otitis Media
Recommendation: Don't prescribe antibiotics for otitis media in children aged 2-12 years with non-severe symptoms where the observation option is reasonable.
Voiding Cystourethrogram (VCUG) for First Febrile Unrinary Tract Infection in Young Children
Recommendation: Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.
Prostate Cancer Screening Using a Prostate-specific Antigen (PSA) Test or Digital Rectal Exam
Recommendation: Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.
Scoliosis in Adolescents
Recommendation: Do not screen adolescents for scoliosis.
Pelvic Exam or Physical Exams to Prescribe Oral Contraceptive Medications
Recommendation: Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications.
Elective, Non-medically Indicated Inductions of Labor or Cesarean Deliveries Before 39 Weeks*
Recommendation: Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age.
Elective Inductions of Labor Between 39 and 41 Weeks*
Recommendation: Avoid elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable.
Screening for Carotid Artery Stenosis in Asymptomatic Adult Patients
Recommendation: Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients.
Screening for Cervical Cancer in Women Older Than 65 Years of Age
Recommendation: Don’t screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
Screening for Cervical Cancer in Women Younger than 30 Years of Age
Recommendation: Don’t screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology.
Imaging for Low Back Pain
Recommendation: Don't do imaging for low back pain within the first six weeks, unless red flags are present.
Antibiotics for Sinusitis
Recommendation: 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.
DEXA for Osteoporosis
Recommendation: Don't use dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 or men under 70 with no risk factors.
Annual EKGs for Low-risk Patients
Recommendation: Don't order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.
Recommendation: Don't perform Pap smears on women under the age of 21 or women who have had a hysterectomy for non-cancer disease.
*The AAFP has collaborated with the American Academy of Obstetricians and Gynecologists to develop the recommendations listed above regarding induction of labor.
The recommendations listed above are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.