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Choosing Wisely recommendations

The American College of Physicians offers these Choosing Wisely recommenda- tions in addition to the two listed at right:

1. In the evaluation of simple syncope and a normal neuro- logical examination, don’t obtain brain imaging studies (CT or MRI).

2. In patients with low pretest probability of venous thromboem- bolism (VTE), obtain a high-sensitive D-dimer measure- ment as the initial diagnostic test; don’t obtain imaging studies as the initial diagnostic test.

3. Don’t obtain preop- erative chest radiog- raphy in the absence of a clinical suspi- cion for intrathoracic pathology., and join the #TMASMA (TMA Social Media Advocacy) campaign.

3. Engage. Come to First Tuesdays at the Capitol to lobby in person. Mark your calendar for these re- maining dates: April 7 and May 5. Register today at /firsttuesdays.

4. Speak out. Watch for TMA action alerts, and be ready to call, write, or visit your legislators before critical votes on key issues.

Internist applies Choosing Wisely as reinforcement for patients’ concerns

LISA EHRLICH, MD, uses the Choos- ing Wisely initiative when speaking with her patients about unnecessary medical procedures. The Houston internist and chair of TMA’s Coun- cil on Health Care Quality says that many patients request examinations that would not necessarily help their medical issue and could potentially cause harm. With reinforcement from Choosing

Wisely, Dr. Ehrlich is able to steer pa- tients in the right direction. The Choosing Wisely campaign

is used to promote healthy dialogue between physicians and their pa- tients. Begun in 2012, this physician- led movement attempts to eliminate unnecessary tests and procedures predicated on evidence-based recom- mendations. These recommendations come from leading medical specialty societies that have identified the five most salient issues patients could discuss with their physicians. TMA is working with the ABIM Founda- tion and the Rob- ert Wood Johnson Foundation to make physicians and the public more aware

Lisa Ehrlich, MD 16 TEXAS MEDICINE March 2015

of the lists and encourage their use. Dr. Ehrlich is using the Choosing

Wisely recommendations from the American College of Physicians (ACP) when consulting with her patients. The first two recommendations from the list are the most important for her practice, she says.

• Don’t obtain screening exercise electrocardiogram testing in indi- viduals who are asymptomatic and at low risk for coronary heart dis- ease.

• Don’t obtain imaging studies in pa- tients with non-specific low back pain.

“We have a lot of false-positives

from stress EKG tests,” Dr. Ehrlich said, “about 15 percent from males, and an upward of 30 percent from fe- males.” Dr. Ehrlich states that this test is not necessarily helpful for low-risk and asymptomatic individuals. The use of imaging for non-specific

back pain is another important rec- ommendation Dr. Ehrlich quite often confronts in her practice. “We use an MRI from the back

or neck if we think something is en- croaching on the spinal column that would then require surgical interven- tion,” she said. “If we are going to do anti-inflammatory medication and physical therapy, then an MRI would not change our management for that. “Choosing Wisely is a very easy thing

that I can show the patient that these tests are not necessary and would not change my management.” When asked why she would recom-

mend it to other physicians, Dr. Eh- rlich said she believes “the initiative is important in getting physicians to think about how they can start talk- ing to patients.” In the future, Dr. Ehr- lich will continue to use the Choosing Wisely recommendations when dis- cussing tests and procedures with her patients. For more information, visit TMA’s Choosing Wisely page at www.texmed .org/choosingwisely/.

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