Choosing Wisely

Encouraging conversations between physicians and patients to improve care.

The American Academy of Family Physicians (AAFP) is committed to supporting the Choosing Wisely® campaign with the goal of ensuring high-quality, cost-effective care for patients. The AAFP has identified a list of tests and procedures that both doctors and patients should carefully consider and openly discuss before incorporating them into a treatment plan.

About Choosing Wisely®

The Choosing Wisely®  campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation to improve health care quality. More than 70 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.

Clinical Recommendations

To help reduce unnecessary or harmful treatments and tests, the AAFP recommends that family physicians have conversations with patients regarding the safety and efficacy of:

• Antibiotics for Otitis Media - Choosing Wisely: Choosing Wisely® Recommendation: Don't routinely prescribe antibiotics for otitis media in children aged 2-12 years. 
• Voiding Cystourethrogram (VCUG) for First Febrile Urinary Tract Infection in Young Children - Choosing Wisely: Choosing Wisely® Recommendation: Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months. 
• Prostate Cancer Screening - Choosing Wisely: Choosing Wisely® Recommendation: Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.
• Scoliosis in Adolescents - Choosing Wisely: Due to recently-published evidence related to screening adolescents for scoliosis, the AAFP has withdrawn this recommendation.
• Pelvic Exam or Physical Exams to Prescribe Oral Contraceptive Medications - Choosing Wisely: Choosing Wisely® Recommendation: Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications.
• Elective, Non-medically Indicated Inductions of Labor or Cesarean Deliveries Before 39 Weeks - Choosing Wisely: Choosing Wisely® Recommendation: Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age. 
• Screening for Carotid Artery Stenosis in Asymptomatic Adult Patients - Choosing Wisely: Choosing Wisely® Recommendation: Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients.
• Screening for Cervical Cancer in Women Older Than 65 Years of Age - Choosing Wisely: Choosing Wisely® Recommendation: Don’t screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
• Imaging for Low Back Pain - Choosing Wisely: Choosing Wisely® Recommendation: Don't do imaging for low back pain within the first six weeks, unless red flags are present.
• Antibiotics for Sinusitis - Choosing Wisely: Choosing Wisely® Recommendation: Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis.
• DEXA for Osteoporosis - Choosing Wisey: Choosing Wisely® Recommendation: Don't use dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 or men under 70 with no risk factors. 
• Annual EKGs for Low-risk Patients - Choosing Wisely: Choosing Wisely® Recommendation: Don't order annual EKGs for low-risk patients.
• Pap Smears - Choosing Wisely: Choosing Wisely® Recommendation: Don't perform Pap smears on women under the age of 21 or women who have had a hysterectomy for non-cancer disease.

The AAFP has collaborated with the American Academy of Obstetricians and Gynecologists to develop the recommendations listed above regarding induction of labor.