» Don't perform unproven tests, such as certain immunoglobulin testing, to evaluate allergy.
» Avoid antibiotics for uncomplicated sinus infections.
» Don't routinely do diagnostic testing for patients with chronic urticaria, or hives.
» Generally avoid immunoglobulin replacement therapy for recurrent infections.
» In most cases avoid calling for imaging of lower back pain within the first six weeks.
» Don't use a specific kind of X-ray scan called DEXA for osteoporosis in women younger than 65 and men younger than 70 with no risk factors.
» Avoid annual EKGs and other cardiac screening for low-risk patients without symptoms.
» Don't do Pap smears on women under 21 years of age or those who have had a hysterectomy for noncancer disease.
» Don't perform cardiac stress imaging in first evaluation of patients without cardiac symptoms unless it's a high-risk patient.
» Avoid cardiac stress imaging as a preoperative test for patients about to have low-risk, noncardiac surgery.
» Avoid routine echocardiography for follow-up in mild cases of certain valve diseases when there are no changes or symptoms.
» Don't stent certain lesions in certain uncomplicated heart attack cases.
» In patients without seizures or other neurological signs, don't obtain brain CT scans or MRIs.
» Don't do imaging for uncomplicated headaches.
» Don't do imaging for pulmonary embolism, or sudden blockage of a lung artery, for patients without moderate or high probability of having the disease.
» Avoid preoperative chest X-rays for most patients with normal history and exam.
» Avoid CT scans for suspected appendicitis in children until after ultrasound has been considered.
» Generally don't do follow-up imaging of small, simple cysts in ovaries and fallopian tubes.
» Use lowest effective dose of acid suppression therapy in gastroesophageal reflux disease.
» For patients with abdominal pain syndrome, CT scans shouldn't be repeated unless there is a major change in findings or symptoms.
» Avoid cancer therapy for tumor patients with no strong evidence supporting further anti-cancer treatment, no benefit from prior evidence-based interventions, ineligibility for clinical trial and in certain other cases.
» Don't do CT and PET scans in early prostate cancer patients at low risk for the spread of cancer.
» Avoid cancer screening for dialysis patients with limited life expectancy unless there are symptoms.
» Don't use non-steroid anti-inflammatory drugs for patients with hypertension, heart failure, diabetes and some other diseases.
» Don't do chronic dialysis without a shared decision among patients, families and physicians.
» Avoid heart imaging for patients who are at low risk.
» Reduce radiation exposure in heart imaging whenever possible, including not doing such tests when limited benefits are likely.
Source: Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation
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