Choosing Wisely: Recommendations from Medical Specialties Beyond Rheumatology

Howard Brody, MD, wrote an article for The New England Journal of Medicine calling on professional societies across medicine to create a list of things in their specialties that were very expensive but of limited use. The American Board of Internal Medicine Foundation teamed up other societies, including the American College of Rheumatology (ACR), and began the Choosing Wisely (CW) campaign.

“The whole point of CW is to get doctors to think about what the data show in terms of decision making instead of just reflexively ordering things because you can,” says Charles King, MD, senior rheumatologist with North Mississippi Health Services in Tupelo. “Every time you make a medical decision that is going to require the use of limited resources, you should make it a well-informed one.”

The ACR formulated and released its CW lists for both adult and pediatric patients in 2013. Since the program was started in 2012, more than 60 societies have joined the campaign. Although mainly published with those in that particular specialty in mind, many of the suggestions from other groups can also have an impact on the practice of rheumatology.

Rheumatologists can mine the lists from other societies and find practice gems, especially in areas not usually thought of as part of rheumatology practice.

Dr. Yazdany

Relevant Lessons from Others

“Some of the lessons from other areas of medicine can also be relevant to rheumatologists in their practices,” says Jinoos Yazdany, MD, MPH, assistant professor at the University of California at San Francisco and co-chair of the ACR task force that drew up the adult CW list. “Many societies address imaging for lower back pain in their reports. Suggestions on bone density testing are important to rheumatology. Many of our patients suffer from sleep disorders, making proposals on prescribing certain medications for insomnia in older persons something we should think about.”

One of the more consistent areas of interest is low back pain. The American Academy of Family Physicians (AAFP) noted that imaging for low back pain was not a good idea in the first six weeks without certain red flags. Similar suggestions were published by the American College of Occupational and Environmental Medicine (ACOEM) for injured workers with acute, unspecific low back pain. The American College of Physicians (ACP) also says doctors shouldn’t routinely obtain imaging studies for low back pain that can’t be attributed to a specific disease or abnormality. The North American Spine Society (NASS) argued against advanced imaging, such as MRI of the spine, for low back pain without red flags.