“If I don’t do this test and something goes wrong, how do I defend myself?” We’ve all done it: ordered certain tests or procedures, many quite expensive, “just in case.” The fear and threat of a malpractice claim is probably the main driver of “unnecessary” testing, oftentimes to simply document what we already know and oftentimes to the detriment of the patient.
With input from a number of specialty organizations, the American Board of Internal Medicine Foundation has put together a list of 90 commonly used medical tests and treatments that it deems overused. Here are a few examples:
Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer diseases.
American Board of Family Physicians
Don’t indiscriminately prescribe antibiotics for uncomplicated acute sinusitis.
American Academy of Allergy, Asthma and Immunology
Don’t perform EEGs for headaches.
American Academy of Neurology
Don’t order antibiotics for conjunctivitis (“pink eye”).
American Academy of Ophthalmology
Cough and cold medications should not be prescribed or recommended for respiratory illnesses in children under four years of age.
American Academy of Pediatrics
Don’t perform annual stress cardiac imaging as part of routine follow-up in asymptomatic patients.
American College of Cardiology
Don’t schedule elective, non-medically indicated induction of labor or Cesarean deliveries before 39 weeks 0 days gestational age.
American College of Obstetricians and Gynecologists
Don’t obtain imaging studies in patients with non-specific low back pain.
American College of Physicians
Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
American College of Radiology
Do not repeat colorectal cancer screening (by any method) for 10 years after a high quality colonoscopy is negative in average-risk individuals.
American Gastroenterological Association
Don’t order coronary artery calcium scoring for screening purpose on low-risk asymptomatic individuals except for those with a family history of premature coronary artery disease.
Society of Cardiovascular Computed Tomography
To see the complete list and the reasons behind the recommendations, go to www.choosingwisely.org.
Ken Teufel is the Medical Director for Interim Physicians