Five Common but Unnecessary Tests/Procedures

For the third year in a row, the American Academy of Family Physicians (AAFP) released a list of common tests and procedures that may be duplicative or unnecessary according to research.

The AAFP released the list as part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, which aims to encourage physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

“As primary care specialists, family physicians are the frontline providers for millions of Americans — so we have a duty to make sure our members are doing everything they can to provide the right care, for the right patient, at the right time,” said Reid Blackwelder, MD, FAAFP, president of the AAFP. “In today’s health care environment, it is increasingly important to ensure physicians deliver the most effective, beneficial care possible. These Choosing Wisely lists can help our members identify treatments and procedures that may be wasteful.”

Through Choosing Wisely, more than 50 medical specialty societies have identified common tests, procedures and medications that may not be necessary or beneficial to patients. The AAFP released its first list April 2012 and the second list February 2013. Now, the organization has released another five suggestions.

1. Do not prescribe antibiotics for otitis media in children aged 2 to 12 years with non-severe symptoms where the observation option is reasonable. The decision to observe or treat is based on the child’s age, diagnostic certainty and illness severity.

2. Do not perform voiding cytourethrogram routinely in first febrile urinary tract infection in children between the ages of two to 24 months. The risks associated with radiation outweigh the risk of delaying the detection. Plus, the procedure is uncomfortable and expensive.

3. Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam. Not only will many of the tumors diagnosed not harm patients, but there are significant risks of treatment.

4. Do not screen adolescents for scoliosis as there is no good evidence that screening asymptomatic adolescents detects scoliosis any earlier than detection without screening. Further, screening and treating these adolescents could include unnecessary follow up visits because of false positive test results.

5. Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications. These contraceptives are safe, effective and well tolerated for most and it can be safely provided on the basis of medical history and blood pressure measurement.

“The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system,” Richard J. Baron, president and CEO of the ABIM Foundation, said in a statement.