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Choosing Wisely: Doctors Identify List of 130 Overused Tests

Seventeen leading medical specialty societies have identified specific tests, procedures or medication therapies they say are commonly ordered, but which are not always necessary—and could cause undue harm. To date, more than 130 tests and procedures to question have been released as part of the ABIM Foundation’s Choosing Wisely campaign, which aims to spark conversations between patients and physicians about what care is really necessary.

Each specialty society participating in Choosing Wisely identified five specific tests or procedures that are commonly done in their profession, but whose use should be questioned.

For example, the American Academy of Allergy, Asthma & Immunology includes as part of its “Five Things…”: 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.

  • Appropriate diagnosis and treatment of allergies requires specific IgE testing (either skin or blood tests) based on the patient’s clinical history. The use of other tests or methods to diagnose allergies is unproven and can lead to inappropriate diagnosis and treatment. Appropriate diagnosis and treatment is both cost effective and essential for optimal patient care.

From the American Academy of Family PhysiciansDon’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.

  • There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Potential harms of this routine annual screening exceed the potential benefit.

From the American Academy of PediatricsAntibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).

  • Although overall antibiotic prescription rates for children have fallen, they still remain alarmingly high. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher health care costs and the risks of adverse events.

From the American Society of Clinical OncologyDon’t use cancer-directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anti-cancer treatment.

  • Studies show that cancer directed treatments are likely to be ineffective for solid tumor patients who meet the above stated criteria.
  • Exceptions include patients with functional limitations due to other conditions resulting in a low performance status or those with disease characteristics (e.g., mutations) that suggest a high likelihood of response to therapy.

The Choosing Wisely campaign also includes patient-friendly resources from specialty societies and Consumer Reports, which helped to create the campaign.  Some of the patient lists include:

 

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