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ACOG helps ob-gyns ‘choose wisely’

Dr. Sandra KochSandra Koch, MD, ACOG Committee on Patient Safety and Quality Improvement vice chair

The Choosing Wisely campaign is an initiative of the American Board of Internal Medicine (ABIM) Foundation designed to help patients and physicians engage in conversations about the overuse of tests and procedures and to support physician efforts to help patients make smart and effective care choices. Leading specialty societies have created lists of evidence-based recommendations that should be discussed.

The campaign recognizes that patients often ask for tests or treatments that are not necessarily in their best interest and that physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible outcomes. It was launched to create and disseminate evidence-based lists of five tests and/or procedures by specialty whose necessity should be questioned by both physicians and patients.

The Choosing Wisely campaign has received a lot of attention and created a unique opportunity for ACOG to improve health care literacy. ACOG has already submitted the following five evidence-based recommendations to Choosing Wisely:

  • 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 screening (Pap tests) in women 30–65 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

Recommendations currently under consideration for a second list are:

  • Don’t use terbutaline for more than 48 hours to prevent preterm labor
  • Don’t use robotic surgery when it is not indicated
  • Don’t perform keepsake ultrasounds
  • Don't perform pelvic ultrasounds in asymptomatic, non-pregnant women
  • Don’t perform urodynamic testing in a woman with simple urinary stress incontinence
  • Don’t prescribe bed rest during pregnancy
  • Don’t use a fetal fibronectin to test for preterm labor in asymptomatic pregnant women
  • Don’t routinely transfuse for hemoglobin over 7 g/dl

If you have an idea you would like ACOG to consider for submission to the Choosing Wisely campaign, please email it to me at koch-mcfarren@sbcglobal.net.