Editor's note: This column was published in October 2013 when the Choosing Wisely program was being introduced. It appears today in response to the commentary by columnist Scott Rasmussen which appeared last Saturday (May 17) in the Independent.
The art and science of medical practice and patient care have been undergoing dramatic changes since the times of physician-god Imhotep and physician-philosopher Hippocrates through the Middle Ages to our modern society of technological sophistication and government-assisted health care. Our contemporary medical practice only vaguely resembles that of Civil War society and has little in common with the face of medicine in the 1960s, just 50 years ago.
Recent information published by the American Board of Family Medicine (AAFP) states: "The Choosing Wisely campaign was created as an initiative of the American Board of Internal Medicine Foundation to improve health care quality. More than 50 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused."
In addition, the AAFP relates: "[that it] remains committed to supporting the Choosing Wisely campaign with the goal of ensuring high-quality, cost-effective care to patients. The AAFP has identified [more than] 15 tests and procedures that both doctors and patients should carefully consider and openly discuss before incorporating them into a treatment plan."
In summary of the above statements, groups of physicians have published statements and recommendations regarding common medical conditions and procedures which may lend themselves to new concepts and attitudes by physicians and patients. Notably, these comments by the specialty societies are general in nature, and specific illnesses and situations may often require specific or alternative directions. These thoughts are not laws, specific guidelines, or definitive answers to often puzzling patient illnesses or situations. The individual doctor-patient relationship ultimately determines the final action.
Today's column (and subsequent ones] will describe and briefly discuss the majority of these topics and recommendations; you will notice that these statements reflect new ideas, current research, and significant changes from former practices and recommendations.
Again, the AAFP states regarding the Choosing Wisely program: " To help reduce unnecessary or harmful treatments and tests, the AAFP recommends that family physicians have conversations with patients regarding the safety and efficacy of [the following]:
Antibiotics for Otitis Media (Ear Infections) - The recommendation suggests that antibiotics NOT be used for otitis media in children aged 2-12 with non-severe symptoms where the observation option is reasonable. It is a well-recognized fact that antibiotic resistance resulting from antibiotic over use has greatly decreased the effectiveness of our antibiotic chemotherapy;
Prostate Cancer Screening- The recommendation is that NO routine screening tests such as the digital rectal exam or PSA blood test are to be performed;
Scoliosis in Adolescents- The recommendation is that NO screening is necessary;
Screening for Carotid Artery Stenosis in Asymptomatic Adult Patients- The recommendation is that NO screening is necessary;
The Prescription of Oral Conceptive Medications- The recommendation is that NO general or pelvic examinations are routinely required to prescribe oral contraceptive medications.
These recommendations may be surprising to our readers. However, they are the results of statistically significant studies of the value, costs, and possible harm to patients and society related to previous treatments and recommendations.
More information on the general topic of Choosing Wisely and the approach to specific medical conditions is available on the Internet; check the website: www.choosingwisely.org/