Table 1. Title and Topic of the 29 Patient-Oriented Evidence That Matters Not Discussed in the Master List of the Choosing Wisely Campaign
TopicPOEM TitleClinical Action to De-Adopt
DiagnosticsAnnual screening chest radiograph does not reduce lung cancer mortalityAnnual screening chest radiograph
Negative high-sensitivity troponin rules out AMIRepeat measurement of HS-troponin within 12 hours of presenting to the emergency department
Repeat BMD testing: little, if any, value in elderly men and womenRepeat testing of BMD
Guideline: When to screen for and treat chronic kidney diseaseScreening eGFR test, urine for albumin
Older adults feel a “moral obligation” to undergo screeningCessation of periodic screening tests in the elderly without taking the time to discuss the issue
Colorectal neoplasia yield similar for FIT every 1, 2, or 3 yearsAnnual FIT
Most tests for rotator cuff disease are inaccurateSelected maneuvers to test for rotator cuff disease
Medical interventionsASA: not for primary preventionASA for primary prevention of cardiovascular disease
Intermittent steroids effective for children with recurrent wheezingDaily inhaled steroids in children with recurrent wheezing
ACP guideline: Universal VTE prophylaxis not recommended for hospitalized medical and stroke patientsAnticoagulation for all medical inpatients
Evidence for combination antipyretics is limitedCombining antipyretics in management of fever in children
24 Months of clopidogrel after stent is no better than 6 monthsMore than 6 months of clopidogrel after stent
Mean duration of cough is 18 days; patients expect about 1 weekAntibiotics for acute bronchitis
Negative CT after mild blunt head trauma in children: send them homeHospitalization after negative CT in children with mild blunt head trauma
Statins of modest benefit for low- to moderate-risk persons (NNT, ∼80)Statins for low- to moderate-risk persons
Niacin not effective in CAD with low HDL-cholesterol (AIM-HIGH)Niacin for low HDL-cholesterol
Nasal steroids ineffective for ET dysfunctionNasal steroids for eustachian tube dysfunction, including otitis media with effusion
Treatment for mild hypertension is ineffectiveAntihypertensive treatment of mild hypertension
Cutaneous warts in children: half disappear within a yearRoutine treatment without a discussion about prognosis of warts in children
Fasting is not necessary before lipid panelsFasting before lipid panels
Steroid injection for lateral epicondylitis worse than saline after 1 yearSteroid injection for epicondylitis
5-Day steroid treatment effective for acute COPD exacerbationMore than 5 days of oral steroids for acute COPD exacerbation
Epidural steroids for sciatica are minimally effective in the short termEpidural steroids for sciatica
Testosterone does not improve the effectiveness of sildenafilTestosterone for erectile dysfunction treated with sildenafil
Limited evidence: manipulation ineffective for acute low-back painSpinal manipulation for acute low-back pain
Placebo almost as effective as hypnotics in adultsNightly hypnotic in adults
Surgical interventionsAsymptomatic gallstones rarely lead to cholecystectomy and may go awayCholecystectomy for asymptomatic gallstones
Surgery + PT similar to PT alone for adults with meniscal tear and OARepair of torn meniscus in adults with OA
Knee injury: rehab = ACL reconstruction for many young adultsACL reconstruction for all young adults
  • ACL, anterior cruciate ligament; ACP, American College of Physicians; AMI, acute myocardial infarction; ASA, aspirin; BMD, bone mineral density; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CT, computed tomography; eGFR, estimated glomerular filtration rate; ET, eustachian tube; FIT, fecal immunochemical test; HDL, high-density lipoprotein; HS, high sensitivity; NNT, number needed to treat; OA, osteoarthritis; PT, physical therapy; VTE, venous thromboembolism.