Medicine
Last month, 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. American Family Physician will soon be updating its list of primary care-relevant items from the Choosing Wisely campaign, and its 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.
From a population health perspective, curtailing prostate cancer overdiagnosis and unnecessary cardiac interventions would be worthy goals to add to a "don't do" list that collectively includes more than one hundred items. Instead, these omissions say quite a bit about the persistence of perverse financial and medicolegal incentives in primary and subspecialty medicine. After all, no one ever sued a doctor for diagnosing cancer (even if it didn't need to be diagnosed) or placing a stent in a partially occluded coronary artery (even if it didn't need to be placed), and insurers rarely (if ever) decline to pay for these wasteful tests and procedures.
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A shortened version of the above post first appeared on the AFP Community Blog.
- Psa Screening By The Numbers: No Benefits, Many Harms
Previous studies found that two-thirds of men who receive prostate-specific antigen (PSA) screening for prostate cancer didn't have shared decision making with their physicians. If shared decision making occurred at all, patients were more likely...
- Will Choosing Wisely Change The Way Family Physicians Practice?
As phase 3 of the Choosing Wisely campaign draws to a close, it's time to start assessing its impact. Family physicians have been at the forefront of this clinician-led movement to reduce waste and prevent harm from unnecessary medical interventions,...
- Low-value Care For Acute Chest Pain In The Ed
Last week, the family medicine residency inpatient service that I supervise admitted several patients from the emergency department with acute chest pain that had resolved. Most of them had no history of cardiovascular disease, but were deemed to have...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Making Wiser Choices About Medical Tests And Treatments
"Sometimes, the hardest thing for a physician to do is nothing," observed my colleague Jay Siwek, MD in a recent editorial in American Family Physician. "And although patients are sometimes a source of excess utilization, physicians,...
Medicine
Choosing Wisely's curious omissions
Last month, 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. American Family Physician will soon be updating its list of primary care-relevant items from the Choosing Wisely campaign, and its 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.
From a population health perspective, curtailing prostate cancer overdiagnosis and unnecessary cardiac interventions would be worthy goals to add to a "don't do" list that collectively includes more than one hundred items. Instead, these omissions say quite a bit about the persistence of perverse financial and medicolegal incentives in primary and subspecialty medicine. After all, no one ever sued a doctor for diagnosing cancer (even if it didn't need to be diagnosed) or placing a stent in a partially occluded coronary artery (even if it didn't need to be placed), and insurers rarely (if ever) decline to pay for these wasteful tests and procedures.
**
A shortened version of the above post first appeared on the AFP Community Blog.
- Psa Screening By The Numbers: No Benefits, Many Harms
Previous studies found that two-thirds of men who receive prostate-specific antigen (PSA) screening for prostate cancer didn't have shared decision making with their physicians. If shared decision making occurred at all, patients were more likely...
- Will Choosing Wisely Change The Way Family Physicians Practice?
As phase 3 of the Choosing Wisely campaign draws to a close, it's time to start assessing its impact. Family physicians have been at the forefront of this clinician-led movement to reduce waste and prevent harm from unnecessary medical interventions,...
- Low-value Care For Acute Chest Pain In The Ed
Last week, the family medicine residency inpatient service that I supervise admitted several patients from the emergency department with acute chest pain that had resolved. Most of them had no history of cardiovascular disease, but were deemed to have...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Making Wiser Choices About Medical Tests And Treatments
"Sometimes, the hardest thing for a physician to do is nothing," observed my colleague Jay Siwek, MD in a recent editorial in American Family Physician. "And although patients are sometimes a source of excess utilization, physicians,...