THINGS PHYSICIANS SHOULD QUESTION Mary Puttmann-Kostecka, MD

Choosing Wisely Campaign  Started via ABIM grant to the National Physicians Alliance.  Created lists for internal medicine, family medicine and pediatrics  Goal is to provide care that is:  Supported by evidence  Doesn’t duplicate information  Truly necessary  Reduced harm

Objectives  Be able to list three studies or procedures that may be common practice but are not indicated.  Be able to explain why some of these studies are excessive.  Explain incidences where you might want to order the study or test anyways.  Apply the guidelines to clinical situations

Case  60yo woman comes for a well adult exam. She requests a bone scan for osteoporosis. She’s been menopausal for 11 years.  You get a TE from the mother of your 15yo patient. She has her usual sinusitis again. It’s day 3 and they want to ‘nip this in the butt’ and get antibiotics on board before it gets worse.  ….you know from past experience she’ll just go to the ED if you don’t prescribe the antibiotics…

AAFP

AAP

Case  38yo 40 weeks by early US who has been miserable the whole pregnancy and is just done with being pregnant. It’s her due date and she really wants to be induced. You check her cervix – it’s midposition and soft, about 60% effaced and 3cm dilated, -2 station. No contractions.  Induce?

ACOG

Case  68yo lady, overweight, underwent hip surgery.  You’re paged by the RN: she’s up 10kg from baseline and tachypneic with a slightly increased O2 requirement.  You go examine her: she as crackles at the bases – you decide to diurese her with lasix  While you write the order the nurse comes by and says she has had several episodes of incontinence overnight and just can’t mobilize herself to the bathroom quickly. …..the nurse suggests a foley – at least the patient can get some sleep…….

Society of Hospital Medicine: Adult Medicine

Cases – who needs tele?  68yo woman with atrial fibrillation rate controlled on BB admitted for a COPD exacerbation.  70yo admitted for CHF exacerbation, rales and SOB on exam.  55yo male, smoker, no hyperlipidemia, crushing chest pain, admitted for rule out ACS  Patient presented with elevated troponins, NSTEMI, also found to have a diabetic ulcer and needs IV abs

Soc of Hosp Medicine: Adults

American Society for Clinical Pathology

Am Academy of Allergy, Asthma and Immunology

American Academy of Neurology

American Academy of Opthalmology

American Academy of Otolaryngology

American College of Physicians

Case  26yo patient with a simple cyst of 3cm on her left ovary incidentally discovered. Does she need a follow-up US?  60yo post-menopausal woman with a 6mm cyst found incidentally on an ED abdominal US. Does she need follow-up?

American College of Radiology

American College of Rheumatology

American Geriatrics Society

American Society of Nephrology

American Urological Association

Society for Vascular Medicine

References   Drew, B. et al. “Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical care Nurses. Circulation. 2004; 110: doi: /01.CIR  Greenlee, R. et all. “Prevalence, incidence and natural history of simple ovarian cysts among women over age 55 in a large cancer screening trial. Am J Obstet Gynecol April: 202(4): 373.e1-373.e9. doi /j.ajog  Sasaki, H et al. “Follow-up of women with simple ovarian cysts detected by transvaginal ultrasonography in the Tokyo metropolitan area. Br J Obstet Gynaecol Mary;106(5):