Pulmonary and endocrine societies identify unnecessary tests

Several medical societies recently released lists of commonly performed pulmonary and endocrine tests and procedures that may not always be necessary, as part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign.

The pulmonary list was produced by a collaborative task force assembled by the American Thoracic Society (ATS) and the American College of Chest Physicians (ACCP).

Their 5 recommendations are:

• Do not perform CT surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines.
• Do not routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left-sided heart disease or hypoxemic lung diseases (groups II or III pulmonary hypertension).
• For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, do not renew the prescription without assessing the patient for ongoing hypoxemia.
• Do not perform CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.
• Do not perform CT screening for lung cancer among patients at low risk for lung cancer.

The endocrine list was produced by a collaborative task force assembled by The Endocrine Society and the American Association of Clinical Endocrinologists (AACE).

Their 5 recommendations are:

• Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.
• Do not routinely measure 1,25-dihydroxyvitamin D unless the patient has hypercalcemia or decreased kidney function.
• Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.
• Do not order a total or free T3 level when assessing levothyroxine (T4) dose in hypothyroid patients.
• Do not prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency.

The Choosing Wisely campaign aims to promote conversations between physicians 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. To date, over 80 national and state medical specialty societies, regional health collaboratives and consumer partners, including ACP, have participated in the campaign, which has covered more than 250 tests and procedures. More information about the campaign is online.