Choosing Wisely

Heritage Family Medicine SUPPORTS "Choosing Wisely"

HFM seeks to be conservative in its use of medical resources and reduce harm to its patients by unnecessary screenings, procedures and treatments. We support the initiative of the American Academy of Family Practice and more than 50 other specialty societies who have identified commonly employed practices that are likely overused or of little value.

"As primary care specialists, family physicians are the front line 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....These Choosing Wisely lists can help our members identify treatments and procedures that may be wasteful."

  • Antibiotics for Otitis Media

Recommendation: Don't prescribe antibiotics for otitis media in children aged 2-12 years with non-sever symptoms where the observation option is reasonable.

  • Antibiotics for Sinusitis

Recommendation: Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days OR symptoms worsen after initial clinical improvement.

  • Prostate Cancer Screening Using a Prostate-Specific Antigen (PSA) Test or Digital Rectal Exam

Recommendation: Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

  • Imaging for Low Back Pain

Recommendation: Don't do imaging for low back pain within the first six weeks, unless red flags are present.

  • DEXA for Osteoporosis

Recommendation: Don't use Dual-Energy X-ray Absorptiometry (DEXA) screening for osteoporosis in women under age 65 or men under 70 with no risk factors.

  • Pap Smears

Recommendation: Don't perform Pap smears on women under the age of 21 or women who have had a hysterectomy for non-cancer disease.

  • Screening For Cervical Cancer in Women Older Than 65 Years of Age

Recommendation: Don't screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

  • Screening for Cervical Cancer in Women Younger Than 30 Years of Age

Recommendation: Don't screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology.

  • Pelvic Exam or Physical Exams to Prescribe Oral Contraceptive Medications

Recommendation: Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications. [However, maintaining that link as a matter of convenience, and a memory aide to ensure USEFUL breast exams, STD screens, and Pap smears when necessary remains HFM policy.]

  • Screening for Carotid Artery Stenosis in Asymptomatic Adult Patients

Recommendation: Don't screen for carotid artery stenosis (CAS) in asymptomatic adult patients. [HFM does offer occasionally scheduled days of Carotid Intimal Thickness Measurement for those patients with medical indications for

same - a different test for specific reasons.]

  • Annual EKGs for Low-risk Patients

Recommendation: Don't order annual electrocardiograms (EKG's) or any other cardiac screening for low-risk patients without symptoms. [HFM strongly supports this recommendation, including, "treadmill EKG's" or "stress tests" without clear necessity - as most often they lead to more unnecessary and expensive studies that lead further to the only possible intervention available of invasive, risky, and even more expensive "heart catheterizations" and coronary artery "stinting" with no proven value over medical management.]

  • Scoliosis in Adolescents

Recommendation: Do not screen adolescents for scoliosis.

  • Voiding Cystourethrogram (VCUG) for First Febrile Urinary Tract Infection in Young Children

Recommendation: Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.

  • Elective, Non-medically Indicated Inductions of Labor or Cesarean Deliveries Before 39 Weeks*

Recommendation: Don't schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age.

  • Elective Inductions of Labor Between 39 and 41 Weeks*

Recommendation: Don't schedule elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable.