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:
- Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
- 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.
- Don’t perform routine annual cervical cytology (Pap tests) in women 30 to 65 years of age.
- Don’t treat patients who have mild dysplasia of less than two years in duration.
- Don’t screen for ovarian cancer in asymptomatic women at average risk.
- Avoid using robotic assisted laparoscopic surgery for benign gynecologic disease when it is feasible to use a conventional laparoscopic or vaginal approach.
- Don’t perform prenatal ultrasounds for non-medical purposes, for example, solely to create keepsake videos or photographs.
- Don’t routinely transfuse stable, asymptomatic hospitalized patients with a hemoglobin level greater than 7-8 grams.
- Don’t perform pelvic ultrasound in average risk women to screen for ovarian cancer.
- 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 http://www.choosingwisely.org/ for more information about Choosing Wisely®.