- Kenny Lin, MD
Last week, the American Board of Internal Medicine Foundation's Choosing Wisely Initiative announced the release of a second round of lists of 5 things that physicians and patients should question, based on evidence that certain tests or procedures are not beneficial in specific clinical situations. AFP will soon be updating our list of primary care-relevant items from the Choosing Wisely campaign, and our Facebook and Twitter accounts will highlight old and new entries daily over the next few months. This AAFP News Now article provides more information about the American Academy of Family Physicians' most recent items, which include elective labor inductions and unnecessary cervical cancer screenings.
Notably absent from the lists of the primary care specialty societies and the American Urological Association is routine prostate-specific antigen (PSA) testing, which both the Cochrane Collaboration and the U.S. Preventive Services Task Force have concluded does not improve men's health outcomes. Even though the American Cancer Society and the AUA still support selective use of the PSA test in older men who have been adequately informed of its potential harms, no medical group supports the still-common practice of ordering PSA screening without first discussing it with the patient.
Another curious omission from the top 5 lists of cardiology and thoracic surgery organizations is angioplasty or coronary artery bypass surgery for stable coronary artery disease, which are frequently performed in the U.S. but have no clinical advantages over initial medical management.
Monday, February 25, 2013
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Choosing Wise is a start - and great that so many medical specialties have already joined in on this effort. That said - it is just a start ... and not unexpected that certain specialties might not list various tests/procedures that they have held "dear" for many years, but which have recently been shown to be at best highly questionable in terms of their validity.
ReplyDeleteBottom Line: A start is better than nothing.
Clinical "Real World" Bottom Line (in my opinion) - A dent will not be made in reducing the cost of medical care until a functioning single-party payer system capable of saying "No" to unreasonable, unindicated and/or exhorbitant testing/procedures is developed ...
Why is it that we have to "start" to "choose wisely" by eliminating tests/proceedures that never were clinically indicated in the first place? We've known from the start that the AFP test is totally worthless, and that the only change in "outcome" by using a fetal monitor is a 20% increase in C-sections WITHOUT a concommitant increase of benefit in maternal-fetal outcome. The AAFP has never supported those of us who refuse to do things just because some sub-specialty group tells us what to do without evidence to back it up. In fact, the AAFP has rolled over to the sub-specialists consistently. It started with allowing sub-specialists like pediatricians/OB?Gyn's/IM to be called "primary care". They aren't. We are, but we are a joke because we have not stood up for who we are. And those of us who do are not supported by the AAFP.
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