Specialty organizations highlight lists of common tests and interventions that should be questioned

Several medical organizations released lists of tests or procedures that might be overused in clinical practice, as part of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation.

In 2012, nine groups supporting the initiative, including ACP, released lists of five commonly used tests or procedures whose necessity should be questioned and discussed. The most recent release added more specialty societies' recommendations to that collection, along with some of the original societies expanding their lists.

Several of the groups' new recommendations may be relevant to internists' practice, including:

American Academy of Family Physicians

• Don't screen for carotid artery stenosis in asymptomatic adult patients.
• 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.
• Don't screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology.

American Academy of Hospice and Palliative Medicine

• Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.
• Don't delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
• Don't leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care.
• Don't recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis.
• Don't use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) gel for nausea.

American Geriatrics Society

• Don't use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
• Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.
• Don't use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
• Don't use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

New lists were also released by the American Academy of Neurology, American Academy of Ophthalmology, American Academy of Otolaryngology–Head and Neck Surgery Foundation, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Rheumatology, American Society for Clinical Pathology, American Society of Echocardiography, American Urological Association, Society for Vascular Medicine, Society of Cardiovascular Computed Tomography, Society of Hospital Medicine, Society of Nuclear Medicine and Molecular Imaging and the Society of Thoracic Surgeons. All of the recommendations are available online.