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SGIM Releases Choosing Wisely List of Recommendations

 , September 12, 2013



SGIM aims to encourage physician and patient conversations by 
identifying five tests or procedures to question, highlighting 
potentially unnecessary—sometimes harmful—care in general internal medicine. 

The Society of General Internal Medicine (SGIM) released today a list of specific tests or procedures that are commonly ordered but not always necessary in general internal medicine as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary. “SGIM is delighted to support the Choosing Wisely campaign,” said SGIM President Eric B. Bass, MD, MPH from Johns Hopkins University School of Medicine. “We believe that general internists have an important role to play in helping patients make informed decisions about tests and procedures that may otherwise be used too often.”

SGIM’s list identified the following five recommendations:

1. Don’t recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin.
2. Don’t perform routine general health checks for asymptomatic adults. 
3. Don’t perform routine pre-operative testing before low-risk surgical procedures.
4. Don’t recommend cancer screening in adults with life expectancy of less than 10 years.
5. Don't place, or leave in place, peripherally inserted central catheters for patient or provider convenience.

“Physicians in General Internal Medicine have a special long-term relationship with their patients. Our goal is to maintain our patients' health and function, to treat their acute and chronic diseases, and to coordinate care with other specialties on behalf of our patients. The Choosing Wisely topics seek to identify areas where we can engage our patients in conversations designed to enhance their health across this spectrum of practice. We are proud to engage in this specialty-defined Choosing Wisely effort to enhance care on behalf of our patients,” said Laurence F. McMahon, MD, MPH (University of Michigan Medical Center), chair of the SGIM ad hoc Choosing Wisely committee.

The SGIM Choosing Wisely list was developed after months of careful consideration and review, using the most current evidence about management and treatment options. An ad hoc committee of  SGIM was impaneled taking advantage of the clinical expertise of members from the existing Clinical Practice and the Evidence-Based Medicine Committees within the Society. Members of the ad hoc committee were then solicited to determine possible topics for consideration. The topics chosen were selected to meet the goals of the Choosing Wisely campaign, taking advantage of the unique clinical perspective of members of the Society in ambulatory General Medicine as well as hospital-based practice. The final topics were selected by a vote of committee members based on the strength of the existing evidence, the unique standing members of the Society have in addressing the clinical topics selected, as well as contributions the recommendations would make in terms of patient safety, quality, and economic impact. The final recommendations were approved by the governing Council of SGIM. 

“SGIM has shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in general internal medicine, but aren’t always necessary,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system.” Over the next year, more than 30 other specialty society partners will release Choosing Wisely lists, including: 

• September 4, 2013 - AMDA – Dedicated to Long Term Care Medicine 
• September 4, 2013 - American College of Surgeons 
• September 4, 2013 - Commission on Cancer—a multidisciplinary program of 
the American College of Surgeons 
• September 11, 2013 - American Academy of Orthopedic Surgeons 
• September 20, 2013 - American Psychiatric Association
• September 23, 2013 - American Society for Radiation Oncology 
• September 24, 2013 - American Academy of Family Physicians** 
• September 26, 2013 - American College of Medical Toxicology and the American Academy of Clinical Toxicology
• October 8, 2013 - American Association for Pediatric Ophthalmology and Strabismus 
• October 9, 2013 - North American Spine Society
• October 14, 2013 - American College of Emergency Physicians 
• October 16, 2013 - American Association of Clinical Endocrinologists/The Endocrine Society 
• October 27, 2013 - American College of Chest Physicians/American Thoracic Society (Pulmonary)
• October 27, 2013 - American College of Rheumatology* 
• October 29, 2013 - American Academy of Dermatology 
• October 29, 2013 - American Society of Clinical Oncology* 
• October 31, 2013 - Society of Gynecologic Oncology
• November 21, 2013 - American Headache Society 
• December 4, 2013 - American Society of Hematology 
• January 11, 2014 - American Association of Critical-Care Nurses/American College of Chest Physicians/American Thoracic Society/Society of Critical Care Medicine (Critical Care)
• February 3, 2014 - Society for Maternal-Fetal Medicine
• February 10, 2014  - Heart Rhythm Society
• February 24, 2014 - American College of Occupational and Environmental Medicine
• February 27, 2014 - American Geriatrics Society* 
• February 28, 2014 - American Academy of Allergy, Asthma & Immunology
• TBD - American Association of Neurological Surgeons 
• TBD - American Society of Anesthesiologists 
• TBD - American Society of Colon and Rectal Surgeons 
• TBD  - Society for Cardiovascular Magnetic Resonance 

* Releasing a second list
** Releasing a third list

To date, more than 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined Choosing Wisely to advance conversations about appropriate care. With the release of more than 30  new lists in late 2013 and early 2014, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.

The campaign also continues to reach millions of consumers nationwide through a stable of consumer and advocacy partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:

• Alliance Health Networks
• Midwest Business Group on Health
• Minnesota Health Action Group
• National Business Coalition on Health
• National Business Group on Health
• National Center for Farmworker Health
• National Hospice and Palliative Care Organization
• National Partnership for Women & Families
• Pacific Business Group on Health
• The Leapfrog Group
• Union Plus
• Wikipedia

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit 


About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit, read our blog, connect with us on Facebook or follow us on Twitter. 

About Choosing Wisely®
First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at  


SGIM is a member-based international association of over 3,400 of the world’s leading academic general internists, who are dedicated to improving access to care for vulnerable populations, eliminating health care disparities and enhancing medical education. The members of the Society advance the practice of medicine through their commitment to providing comprehensive, coordinated, and cost-effective care to adults, educating the next generation of outstanding physicians, and conducting cutting-edge research to improve quality of care and clinical outcomes of all patients.


Review Rating:

A systematic review showed. We just saved someone's life and #SGIM recommends against routine general health checks based on "lack of data" … A systematic review showed... okay, stop right there, to make such an unreasonable statement you need to evaluate the limitations of it Choose wisely & read original articles. auscultation valuable. vs. … v #ChoosingWisely Intensity may vary, but presence thereof is different #AHRQ #AAFP Auscultate & even if asymptomatic,


Review Rating:

Do you have details on your recommendation for not performing routine health checks on asymptomatic adults? I would assume this would not include women who are greater than age 50 who should have yearly breast exam and for women in general in the age group who require Pap smear screening. Also, please comment on bp screening. In what context should this be done if pt's are not seen for acute visit for several years? Also, much behavioral counseling occurs during a preventive visit- when would screening for at risk behaviors occur- STD, ETOH use, TBC use, depression ,etc?


Review Rating:

At what age do you start figuring the 10 years? In my family many have lived active healthy lives through their late 90's and early 100's. Who has the right to decide how long I'm going to live and the quality of life I'll be allowed in those last 10 years. As I'll be 77 next month will my internist decide 87 years is enough? I've lead a healthy active life and expect to be alive and kicking at 87!+


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