Choosing Wisely: New Practices to Avoid in Family Medicine

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

The American Academy of Family Physicians has released five practices clinicians should question, as part of the Choosing Wisely campaign. Among them:

• Pelvic exams shouldn't be performed on asymptomatic women who aren't pregnant, other than for guideline-recommended cervical cancer screening.

• Self-monitoring of blood glucose should not be regularly recommended for patients with type 2 diabetes who aren't taking insulin or other drugs associated with hypoglycemia.

• Screening asymptomatic adults, including pregnant women, for genital herpes simplex virus infection isn't recommended. The positive predictive value of the test is estimated to be around 50% in the U.S.

• Asymptomatic adolescent and adult males shouldn't be screened for testicular cancer, given the low incidence rate and the high rate of cure.

• Clinicians shouldn't transfuse more than the minimum number of units of red blood cells to ease symptoms of anemia or return patients to safe hemoglobin levels, 7–8 g/dL for stable patients.