Choosing Wisely: American Association of Family Physicians

JHC_Sept14-185526672Conversation Needed

“The most important goal of Choosing Wisely is to provide evidence-based suggestions that can help improve our patients’ healthcare quality,” says Reid Blackwelder, MD, FAAFP, professor and director of undergraduate medical education, Kingsport Center, East Tennessee State University, and president of the American Academy of Family Physicians. “Our recommendations aim to reduce unnecessary, or even harmful, treatments and tests by encouraging conversations between physicians and patients.”

Family physicians want these kinds of conversations to occur, he says. “We want to work with our patients to address the triple aim of improving their health outcomes, improving their satisfaction, and reducing unnecessary expenses.” Together, doctor and patient can carefully consider and openly discuss tests and treatments in the critical context of the particular patient, he adds.

AAFP’s recommendations are just that – recommendations. “These are not hard and fast rules,” says Blackwelder. “We do not treat diseases or conditions, we treat people.”

AAFP has been particularly active in the Choosing Wisely campaign, listing 15 things that physicians and patients should question. “After making 15 recommendations, we believe it is time to do some review and assessment,” says Blackwelder. “Right now we are looking at our members’ acceptance, and that of their patients, of the Choosing Wisely recommendations. We want to explore what barriers might keep patients and physicians from embracing these recommendations, and how we may be able to assist with the shared decision-making process.”

“We are really good at helping our patients change behaviors, and now we get to be part of changing ours.”

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AAFP: Fifteen Things Physicians and Patients Should Question

  1. Don’t do imaging for low back pain within the first six weeks, unless red flags are present.
  2. 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.
  3. Don’t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.
  4. Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.
  5. Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.
  6. Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age.
  7. Avoid elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days, unless the cervix is deemed favorable.
  8. Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients.
  9. 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.
  10. Don’t screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology.
  11. Don’t prescribe antibiotics for otitis media in children aged 2–12 years with non-severe symptoms where the observation option is reasonable.
  12. Don’t perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2–24 months.
  13. Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.
  14. Don’t screen adolescents for scoliosis.
  15. Don’t require a pelvic exam or other physical exam to prescribe oral contraceptive medications.

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