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Friday, February 22, 2013

Five (more) services you should avoid

The American Academy of Family Physicians (AAFP) has released a second list of tests and procedures that tend to be overused and merit scrutiny on the part of family physicians and patients. The five recommendations are part of a national campaign called Choosing Wisely, and they include the following:

1. Don't schedule elective, nonmedically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age.

2. Avoid elective, nonmedically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable.

3. Don't screen for carotid artery stenosis in asymptomatic adult patients.

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

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

The AAFP has provided a downloadable resource that lists the rationale and literature supporting each of these recommendations. It also includes the initial list of recommendations, which addressed imaging for back pain within the first six weeks, antibiotics for mild to moderate sinusitis, annual EKGs for low-risk patients, DEXA screening in younger patients, and Pap smears in young women who have had a hysterectomy.

The AAFP is one of nine specialty societies taking part in the Choosing Wisely campaign spearheaded by the American Board of Internal Medicine Foundation to identify over-utilized services and encourage discussions between physicians and patients.

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