Choosing Wisely: American Academy of Allergy, Asthma and Immunology

Take a Step Back

Choosing Wisely is about practicing quality medicine, not merely pointing out tests and procedures that don’t change outcomes or clinical management, says Theodore Freeman, MD, who sits on the executive committee of the American Academy of Allergy, Asthma and Immunology, and who helped compile the Academy’s Choosing Wisely recommendations. What constitutes “quality medicine” varies from patient to patient, and may vary in the same patient over time, he adds.

“What we have to avoid is the feeling that just because a test or procedure can be beneficial in a certain diagnosis in some circumstances, that the test or procedure is beneficial in most or all circumstances. It is only human when a technique has proven successful in one case, to apply it again and again.

“Quality medicine does not require that exhaustive testing or procedures be done for each patient. It does require a thoughtful application of diagnostic and therapeutic procedures tailored to each patient. Choosing Wisely reminds each of us to step back and assess the value of each test and procedure we undertake for each patient we see.”

The Choosing Wisely campaign helps the medical community addresses two significant barriers to change – habit and patient resistance. “Since Choosing Wisely is available to patients, it addresses their resistance and encourages them to discuss tests and procedures with their physicians, which helps to address the physician’s habits even if the physicians do not read Choosing Wisely criteria themselves,” says Freeman.

And when he talks about “physicians,” Freeman is referring to more than AAAAI members. “It has wider appeal, and each item should be considered a recommendation to all primary care practitioners, who deal with diagnosis. Practicing quality medicine should be important to every physician. The importance should be self-evident and innate in every physician, not just members of the AAAAI.”

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AAAAI: Five Things Physicians and Patients Should Question

  1. Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.
  2. Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
  3. Don’t routinely do diagnostic testing in patients with chronic urticaria.
  4. Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.
  5. Don’t diagnose or manage asthma without spirometry.

Source: Choosing Wisely, an initiative of the ABIM Foundation,
http://www.choosingwisely.org/wp-content/uploads/2013/02/Choosing-Wisely-Master-List.pdf