Is it Necessary

Helping Clinicians and Patients Eliminate Unnecessary Tests and Procedures

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The American Board of Internal Medicine Foundation, nine U.S. specialty medical societies, and Consumer Reports have partnered in a new initiative called Choosing Wisely™.[1] The goal of the initiative is to help physicians, patients, and other healthcare stakeholders start thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit—and in some instances, harm. The idea for the initiative came from the National Physicians Alliance, which piloted a similar project in 2009.

The initiative is fueled in part by some alarming statistics and projections about U.S. healthcare expenditures. The Centers for Medicare & Medicaid Services (CMS) projects that if U.S. healthcare spending continues at current levels, it will reach $4.3 trillion—19.3% of the nation’s gross domestic product—by 2019.[2] And according to the Congressional Budget Office, as much as 30% of care provided in the United States consists of unnecessary tests, procedures, medical appointments, hospital stays, and other services that may not improve people’s health.[3]

Each participating medical society was charged with identifying and listing five tests or procedures commonly used in their field that should be red flags for further discussion. Dubbed “Five Things Physicians and Patients Should Question,” the lists are designed to help physicians and patients think and talk about overuse or misuse of healthcare resources. The resulting lists represent specific, evidence-based recommendations that physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each society’s five-question list provides information as to when the tests and procedures may be appropriate, as well as the methodology used in creating each list. In addition to these nine medical societies, eight more have signed on to the campaign and are scheduled to release their lists this fall.

Some of the recommendations presented by the various medical societies include

  • Don’t perform Pap smears on women younger than 21 years or who have had a hysterectomy for noncancer disease. (American Academy of Family Physicians)
  • Don’t routinely do diagnostic testing in patients with chronic urticaria. (American Academy of Allergy, Asthma & Immunology)
  • Don’t perform stress cardiac imaging or advanced noninvasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present. (American College of Cardiology)
  • Don’t obtain imaging studies in patients with nonspecific low back pain. (American College of Physicians)
  • Don’t do imaging for uncomplicated headache. (American College of Radiology)
  • Don’t repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals (American Gastroenterological Association)
  • Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis. (American Society of Clinical Oncology)
  • Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms. (American Society of Nephrology)
  • Don’t perform cardiac imaging as a pre-operative assessment in patients scheduled to undergo low- or intermediate-risk non-cardiac surgery. (American Society of Nuclear Cardiology)

The full list of partners and their lists of five questions are at

Jill Shuman, MS, ELS
Published April 5, 2012



  1. Choosing Wisely. The American Board of Internal Medicine Foundation Website. Accessed April 3, 2012.
  2. National Health Expenditure Data. Centers for Medicare & Medicaid Services Website. Updated March 10, 2012. Accessed April 4, 2012.
  3. Orszag PR. Increasing the Value of Federal Spending on Health Care. Congressional Budget Office. Washington, DC: Congressional Budget Office; 2008.