“Choosing Wisely” was created in the US by the ABIM Foundation (American Board of Internal Medicine) recognizing that the concept of “too much medicine” is starting to go mainstream and that even consumers are demanding that medical specialties start assessing which services they deliver that could be deemed potentially useless, unnecessary or harmful.
1. Don’t order annual physicals for healthy people. The ritual of patients showing up every year for an ‘annual checkup’ when already feeling perfectly healthy isn’t proven to contribute to the quality and length of patients’ lives. Sorry, at the same time, patients should see their doctor to get any symptom, worry or concern immediately checked out. Our docs are there to help determine what might be wrong and provide some signposts on how to fix things.
2. Don’t give statins (cholesterol-lowering drugs) to anyone unless the person can prove they have heart disease, understands the low possibility of benefit, has read a comprehensive list of statin-related adverse effects and begs politely for a script, using the term “pretty please with sugar on top.”
3. Don’t routinely offer a PSA test to otherwise symptomless, healthy men. Which is to say, stop offering a prostate screening test that is statistically more likely to ruin a healthy man’s life than save it.
4. Don’t routinely push women to get their mammograms done. The main exceptions here are women who have a strong family, genetic or personal history of breast cancer and who have read and understood fully the evidence around mammography and their chances of having a false positive, false negative or an unnecessary biopsy.
5. Don’t offer anyone – no woman, man or beast – a bone density test. This test will only add anxiety and fear to a person’s list of woes. It won’t prove anything and it won’t help anyone except by adding revenues to osteoporosis drug makers and companies that make and operate bone density test machines. Read more…