AAFP joins Choosing Wisely campaign to cut use of unnecessary medical interventions

posted 04.12.12

AAFP has joined eight other medical specialty organizations to launch the Choosing Wisely campaign, an initiative of the ABIM Foundation. Choosing Wisely aims to reduce unnecessary medical interventions by identifying 45 specific tests or procedures commonly used within various specialties that are not always necessary and by urging patients to question these services if offered.

According to the Congressional Budget Office and reported in AAFP News Now, as much as one-third of care provided in the United States consists of unnecessary tests, procedures, medical appointments, hospital stays, and other services that may not improve people’s health. And JAMA reports that physician decisions account for about 80 percent of health care expenditures. CMS projects that if U.S. health care spending continues at current levels, it will reach $4.3 trillion, or 19.3 percent of the nation’s gross domestic product, by 2019.

“The Academy’s involvement in the Choosing Wisely campaign underscores family physicians’ long-term commitment to ensuring high-quality, cost-effective care to patients,” said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., in a prepared statement.

As part of the campaign, each society endorsed a list of five tests and procedures that are commonly used in their specialty but are sometimes unnecessary or harmful to patients. AAFP recommends that family physicians and patients carefully consider and discuss these items before incorporating them into a treatment plan. The items identified for the family medicine include:

• Imaging for low back pain,
• Antibiotics for acute short-term sinusitis,
• DEXA screening for young patients,
• EKGs for asymptomatic, low-risk patients, and
• Pap smears for young or low-risk women.

The announcement sparked praise and criticism from family physicians. TAFP member and blogger Richard Young, M.D., writes positively about the national call to reduce medical testing, saying that the health care system needs “a lot more attitude of ‘when in doubt, don’t.’” And while AAFP member and physician blogger Mike Sevilla, M.D., writes that he agrees with the actions of the Academy, he says that the campaign appears to “blame” doctors for the cost of health care. He questions the responsibility of the patient in not demanding certain tests and whether this could embolden health insurers to expand preauthorization burdens, and he is skeptical whether this will effectively influence the behavior of physicians.

In a New York Times article, Dr. Eric Topol, chief academic officer of Scripps Health, a health system based in San Diego, said the measures “all sound reasonable.”

“But don’t forget that every person you’re looking after is unique. This kind of one-size-fits-all approach can be a real detriment to good care.”

For more information on Choosing Wisely, read AAFP’s coverage on the announcement or go to www.choosingwisely.org/.