Choosing Wisely

American College of Chest Physicians and American Thoracic Society release list for inclusion in Choose Wisely Campaign

By Michael L. Smith, R.R.T., J.D.

(October 31, 2013) - The Choosing Wisely Campaign is a program of the America Board of Internal Medicine Foundation designed to educate patients and physicians about tests, treatments, and procedures that are often overused, misused, or ineffective. According to some estimates, 30% of the $2 trillion Americans spend on healthcare each year is wasted on unnecessary or ineffective treatments and procedures. The Choosing Wisely Campaign is designed to aid physicians and patients in discussions about their care so the patients, with the aid of their physicians, can make intelligent choices about their care.

So far, more than 40 specialty medical societies have developed lists of tests, treatments and procedures that physicians and patients should question. Each list includes five specific tests or procedures that are overused or unnecessary based upon evidence-based medicine.

The American College of Chest Physicians and the American Thoracic Society jointly released a list on Oct. 27, 2013, for inclusion in the Choosing Wisely Campaign. The list released by the American College of Chest Physicians and the American Thoracic Society recommends against the following five tests, treatments and procedures.

1. Don't perform computed tomography (CT) surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines.

2. Don't routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (Groups II or III pulmonary hypertension).

3. For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don't renew the prescription without assessing the patient for ongoing hypoxemia.

4. Don't perform chest computed tomography (CT angiography) to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.

5. Don't perform CT screening for lung cancer among patients at low risk for lung cancer.

The lists of all the contributing medical societies is available from the American Board of Internal Medicine website.

The Choosing Wisely Campaign should be a significant aid to physicians that feel pressured to practice defensive medicine. The list should also be helpful for physicians to educate their patients who are requesting unnecessary treatments or procedures based upon advertisements the patients have seen.

Michael L. Smith, JD, RRT is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla. This article is for general information only and is not a substitute for formal legal advice.

This article was originally published in Advance for Respiratory Care and Sleep Medicine.