30 Things Physicians and Patients Should Question

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Choosing Wisely, an initiative of the American Board of Internal Medicine, released today 26 lists of things physicians and patients should question, compiled by societies in different medical areas.

Each society came up with 5 to 10 pieces of advices for physicians and patients. Below are some notable ones:

- Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age.

- Don’t screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology.

- Don’t use PET/CT for cancer screening in healthy individuals.

- Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.

- Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.

- Don’t perform electroencephalography (EEG) for headaches.

- Don’t order computed tomography (CT) scan of the head/brain for sudden hearing loss.

- Don’t use opioid or butalbital treatment for migraine except as a last resort.

- Don’t use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) gel for nausea.

- Don’t order antibiotics for adenoviral conjunctivitis (pink eye).

- Don’t routinely provide antibiotics before or after intravitreal injections.

- Don’t diagnose or manage asthma without spirometry.

- 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.

- Don’t routinely do diagnostic testing in patients with chronic urticaria.

- Don’t prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea.

- Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).

- Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.

- Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.

- Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.

- Do not repeat colonoscopy for at least five years for patients who have one or two small (< 1 cm) adenomatous polyps, without high-grade dysplasia, completely removed via a high-quality colonoscopy.

- Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.

- Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.

- Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.

- Don’t use bleeding time test to guide patient care.

- Avoid nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes. The use of NSAIDS, including cyclo-oxygenase type 2 (COX-2) inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate

- Don’t perform repetitive CBC and chemistry testing in the face of clinical and lab stability. 

- Don’t use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen.

- Don’t perform cardiac imaging for patients who are at low risk.

- Patients who have no cardiac history and good functional status do not require preoperative stress testing prior to non-cardiac thoracic surgery.

- Patients with suspected or biopsy proven Stage I NSCLC do not require brain imaging prior to definitive care in the absence of neurologic symptoms.


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