Choosing Wisely®: Five More Things Physicians and Patients Should Question

As obstetrician-gynecologists, we understand the importance of providing safe, high quality care for our patients. But as the nation focuses on better ways to provide this care, the overuse of resources is an issue of considerable concern and many experts agree that the current way health care is delivered in this country contains too much waste and inefficiency. It’s crucial that providers across all specialties and patients work together to have conversations about wise treatment decisions. That’s why ACOG is a proud partner of Choosing Wisely®, a campaign led by the American Board of Internal Medicine (ABIM) Foundation, with a goal of advancing a national dialogue on avoiding unnecessary medical tests, treatments and procedures.  The key word here is “unnecessary.”

ACOG has now released its list of “Five More Things Physicians and Patients Should Question” in obstetrics-gynecology. This list builds on the original “Five Things Physicians and Patients Should Question” released in February 2013.

The combined list includes ten evidence-based recommendations that can support ob-gyns and their patients in making wise choices about their care. The list of ten tests or procedures to avoid as part of the Choosing Wisely® initiative is comprised of the following:

  1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
  2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
  3. Don’t perform routine annual cervical cytology (Pap tests) in women 30 to 65 years of age.
  4. Don’t treat patients who have mild dysplasia of less than two years in duration.
  5. Don’t screen for ovarian cancer in asymptomatic women at average risk.
  6. Avoid using robotic assisted laparoscopic surgery for benign gynecologic disease when it is feasible to use a conventional laparoscopic or vaginal approach.
  7. Don’t perform prenatal ultrasounds for non-medical purposes, for example, solely to create keepsake videos or photographs.
  8. Don’t routinely transfuse stable, asymptomatic hospitalized patients with a hemoglobin level greater than 7-8 grams.
  9. Don’t perform pelvic ultrasound in average risk women to screen for ovarian cancer.
  10. Don’t routinely recommend activity restriction or bed resting during pregnancy for any indication.

This list, and the hundreds of others developed by the Choosing Wisely® initiative are helping stimulate discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

Visit for more information about Choosing Wisely®.

This entry was posted in Women's Health and tagged , , by Mark DeFrancesco. Bookmark the permalink.

About Mark DeFrancesco

Mark S. DeFrancesco, MD is the president of ACOG through April 2016. He is managing partner at Westwood Women’s Health in Waterbury, Connecticut, a division of Women’s Health Connecticut. Dr. DeFrancesco is a founding member of Women’s Health Connecticut, and served as its chief medical officer for many years. A graduate of Yale University, he received his medical education at the University of Connecticut, where he is currently an assistant clinical professor. Dr. DeFrancesco also earned an MBA from the University of New Haven.

6 thoughts on “Choosing Wisely®: Five More Things Physicians and Patients Should Question

  1. I don’t think the evidence supports the idea that inducing women with an unfavorable cervix between 39-41 weeks results in more adverse outcomes–esp C section, compared to women who are still pregnant and allowed to spontaneously go into labor till 41 weeks. Nullips with an unfavorable cervix at 39 weeks have about a 40% risk of CD whether they are induced or not. But evidence does suggest that overall neonatal outcomes may be better in induced pregnancies than expectantly managed women— isn’t that the point of the ongoing ARRIVE trial?

  2. Not sure what “acceptable risks” have to do with the above position. I commend ACOG for leading our specialty by publicly opening debate on methods that have little benefit to our patients while posing significant risk. These evidence based guidelines have been followed by many practicing Ob/Gyns for years. Any cost savings to the healthcare system are a secondary benefit to practices that protect our patients from treatment of “incidentalomas” and unnecessary out of pocket expenses. I look forward to the next 5 recommendations.

  3. Acceptable losses? These current guidelines are consistent with evidence based best medical practices that many of us currently practicing have already been using for several years. I respect and commend ACOG for leading this attempt to avoid inappropriate and costly medicine that often subjects our patients to increased risks from “incidentalomas” and unnecessary medical costs. Saving money with the Choosing Wisely” campaign is a secondary benefit, not the primary focus

  4. How can there be a medical necessity to deliver when you never monitor the umbilical cord? To that end, why does AGOG not have guidelines for cord review during BPP tests?

  5. Of course, acceptable losses right? Makes perfect sense to save money on the backs of women. Simple tests like pap smears or ultrasounds can detect issues that need attention. Aside from that care of endometriosis patients in this country is a travesty. Spending multiple millions on scans never able to detect endometriosis. Instead that takes knowledge and grasp of modern concepts vs old Samsonian myths. You have to know what it looks like, where it is found and how to successfully remove it, but no you move further away from that every year.

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