US specialties list five tests and treatments that doctors and patients can safely avoid

BMJ 2012; 344 doi: (Published 10 April 2012) Cite this as: BMJ 2012;344:e2601
  1. Bob Roehr
  1. 1Washington, DC

Nine US medical specialties have released lists of five tests or procedures that are commonly used but are often unnecessary, which they hope will improve healthcare safety and quality while reducing costs.

The Choosing Wisely campaign “is about physicians and patients having conversations, informed conversations, about making wise choices, about their care, and avoiding unnecessary tests and procedures that are not supported by evidence,” said Christine Cassel at a press briefing in Washington, DC on 4 April. It will be supported by ongoing educational activities.

“Research shows that many doctors feel compelled to accommodate a patient’s request for a certain type of intervention, even when they don’t think that it is beneficial,” she said. “More care is not always better care. As physicians, we need to recognise the importance of these conversations and make sure that the right patient gets the right care at the right time.”

Cassel is president of the American Board of Internal Medicine Foundation, the charity arm of the independent non-profit organisation that evaluates and certifies doctors in internal medicine subspecialties. The board represents 374 000 doctors, about a quarter of all doctors in the US, practising in allergy, asthma and immunology, family medicine, cardiology, internal medicine, radiology, gastroenterology, oncology, nephrology, and nuclear cardiology. An additional eight groups have begun the process and will release their lists in the autumn.

The campaign from family doctors is urging doctors and patients not to seek or perform imaging tests for low back pain of less than six weeks unless red flags are present and to avoid antibiotics for acute mild to moderate sinusitis that has been present for less than seven days and DEXA scans for osteoporosis in women under 65 and men under 70 with no risk factors.

Cardiologists are advising the avoidance of stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high risk markers are present.

And an example from gastroenterologists is for doctors not to repeat colorectal cancer screening (by any method) for 10 years after a negative colonoscopy in patients with average risk.

James Fasules, from the American College of Cardiology, said, “Patients have the idea that more is better. That isn’t always the case; more can lead to further unnecessary studies and going down the wrong pathway.”

Amy Williams, a nephrologist at the Mayo Clinic in Rochester, Minnesota, said it was important that patients heard a consistent message on appropriate care throughout the trajectory of their treatment. That was best accomplished by relying upon evidence based guidelines and educating doctors and patients as to why they were appropriate.

Much of it came down to a relationship of trust between the doctor and patient, Williams told the BMJ. “You have to be incredibly honest with your patients, have the data that you need, and tailor therapy to the needs and risk factors of the individual patient.”

She believed the continued integration of care into large systems of healthcare delivery, and the shift away from fee for service reimbursement were strengthening the practice of evidence based medicine. That would result in more consistent conversations with patients.

Five things physicians and patients should question is at


Cite this as: BMJ 2012;344:e2601