Five things physicians, patients should question

Choosing Wisely is an initiative aimed at promoting conversations between providers and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary.

In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field that should be questioned and discussed. Below is the list from the American Academy of Family Physicians:

1. Lower back pain: Don’t do imaging (X-ray, MRI, etc.) for low back pain within the first six weeks, unless red flags are present.

Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis (bone infection) are suspected.

Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs.

2. Sinusitis: Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days or if symptoms worsen after initial clinical improvement.

Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80 percent of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs.

3. Bone density tests: Don’t use dual-energy X-ray absorptiometry screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors. DEXA is not cost effective in younger, low-risk patients, but is cost effective in older patients.

4. Annual EKG: Don’t order annual electrocardiograms or any other cardiac screening for low-risk patients without symptoms. False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Potential harm from this routine, annual screening exceed the potential benefit.

5. Pap smears: Don’t perform Pap smears on women younger than 21 (regardless of sexual activity) unless the woman is experiencing pelvic pain or vaginal discharge. Pap smears are not helpful in women after a hysterectomy (for non-cancer disease) and there is little evidence for improved outcomes.

For more information and a list of other initiatives, go to

(Courtesy of 86th MDG Patient Safety)