Article Figures & Data
Figures
- Figure 1.
Growth in volume of physician services in the United States per Medicare beneficiary from 2000 to 2009
E&M—evaluation and management services.
Data from the Medicare Payment Advisory Commission.1
Tables
- Table 1.
Most important items listed by each of the initial 9 organizations included in the Choosing Wisely campaign
RECOMMENDATION ORGANIZATION Do not perform unproven diagnostic tests, such as immunoglobulin G testing or an indiscriminate battery of immunoglobulin E tests, in the evaluation of allergy AAAAI Do not do imaging for low back pain within the first 6 weeks, unless red flags are present AAFP Do not perform stress cardiac imaging or advanced noninvasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present ACC Do not obtain screening exercise electrocardiograms in individuals who are asymptomatic and at low risk of coronary artery disease ACP Do not do imaging for uncomplicated headache ACR For pharmacologic treatment of patients with gastroesophageal reflux disease, long-term acid suppression therapy (proton pump inhibitors or histamine-2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals AGA Do not use cancer-directed therapy for patients with solid tumours with the following characteristics: low performance status, no benefit from previous evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment ASCO Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms ASN Do not perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present ASNC AAAAI—American Academy of Allergy, Asthma and Immunology, AAFP—American Academy of Family Physicians, ACC—American College of Cardiology, ACP—American College of Physicians, ACR—American College of Radiology, AGA—American Gastroenterological Association, ASCO—American Society of Clinical Oncology, ASN—American Society of Nephrology, ASNC—American Society of Nuclear Cardiology.
The original “Five Things Physicians and Patients Should Question” released in April 2012 Do not do imaging for low back pain within the first 6 weeks, unless red flags are present
Do not routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for 7 or more days, or symptoms worsen after initial clinical improvement
Do not use dual-energy x-ray absorptiometry screening for osteoporosis in women younger than 65 years or men younger than 70 years with no risk factors
Do not order annual electrocardiograms or any other cardiac screening for low-risk patients without symptoms
Do not perform Papanicolaou tests for women younger than 21 years or who have had a hysterectomy for noncancer disease
The second “Five Things Physicians and Patients Should Question” released in February 2013 Do not schedule elective, non-medically indicated inductions of labour or cesarean deliveries before 39 weeks, 0 days gestational age*
Avoid elective, non–medically indicated labour induction between 39 weeks, 0 days, and 41 weeks, 0 days, unless the cervix is deemed favourable*
Do not screen for carotid artery stenosis in asymptomatic adult patients
Do not screen women older than 65 years of age for cervical cancer who have had adequate previous screening and are not otherwise at high risk of cervical cancer
Do not screen women younger than 30 years of age for cervical cancer with human papillomavirus testing, alone or in combination with cytology
The third “Five Things Physicians and Patients Should Question” released in September 2013 Do not prescribe antibiotics for otitis media in children aged 2 to 12 years with nonsevere symptoms where the observation option is reasonable
Do not perform voiding cystourethrogram routinely in first febrile urinary tract infection in children aged 2 to 24 months
Do not routinely screen for prostate cancer using prostate-specific antigen testing or digital rectal examination
Do not screen adolescents for scoliosis
Do not require a pelvic examination or other physical examination to prescribe oral contraceptive medications
Data from the American Academy of Family Physicians.9
↵* Written in collaboration with the American College of Obstetricians and Gynecologists to develop the final language.
