As part of the ABIM Foundation's Choosing Wisely campaign, three specialty societies have created new lists of common but often unnecessary tests or procedures that doctors should be more thoughtful about performing, Medscape Medical News reported.
The new evidence-based recommendations released by the American Academy of Orthopaedic Surgeons (AAOS), the American College of Surgeons (ACS) and the Society of General Internal Medicine (SGIM) include the following:
- Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
- Don't use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.
- Don't use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.
- Don't use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
- Don't use post-operative splinting of the wrist after carpal tunnel release for long-term relief.
- "Don't perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.
- Avoid the routine use of 'whole-body' diagnostic computed tomography (CT) scanning in patients with minor or single-system trauma.
- Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.
- Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
- Don't use CT for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option."
- "Don't recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin.
- Don't perform routine general health checks for asymptomatic adults.
- Don't perform routine pre-operative testing before low-risk surgical procedures.
- Don't recommend cancer screening in adults with life expectancy of less than 10 years.
- Don't place, or leave in place, peripherally inserted central catheters for patient or provider convenience."
These lists are not meant to blacklist certain procedures, but should encourage a discussion between doctors and patients about their usefulness in particular circumstances, noted Laurence F. McMahon, M.D., MPH, from the University of Michigan Medical Center, Ann Arbor, and chair of the SGIM ad hoc Choosing Wisely committee, in an SGIM news release.
"Our goal is to maintain our patients' health and function, to treat their acute and chronic diseases, and to coordinate care with other specialties on behalf of our patients, " he said in the statement. "The Choosing Wisely topics seek to identify areas where we can engage our patients in conversations designed to enhance their health across this spectrum of practice. We are proud to engage in this specialty-defined Choosing Wisely effort to enhance care on behalf of our patients,"