What Medical Procedures Are Necessary?

The American Association of Family Physicians lists procedures that are wasteful and risky

/ Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

(RxWiki News) Many common medical procedures are done because they have become the standard. It's important that doctors and patients understand that there may be better options. 

The American Association of Family Physicians (AAFP) has released a set of five guidelines regarding various common medical procedures that they believe are often unnecessary.

These guidelines are meant to inform both patients and doctors that there may be safer and more beneficial methods of treatment. The AAFP wants patients to be able to be part of the conversation and make informed decisions about their health.

The guidelines include recommendations on pediatric medical procedures, pelvic and prostate exams, and scoliosis. Most of the guidelines focus on the potential risks of these procedures, and how they outweigh the risks of taking a less aggressive treatment route.

"Talk to your doctor about the safest and most effective treatments."

These guidelines were released as part of the Choosing Wisely: An Initiative of the American Board of Internal Medicine Campaign. The campaign is a nationwide effort on behalf of the medical community to inform patients and doctors alike about common tests, procedures and medications that may be unnecessary, unsafe, or wasteful.

This recent set of guidelines is the third list released by the AAFP:

  • Do not prescribe antibiotics for otitis media [infection of the middle ear] in children aged 2-12 years with non-severe symptoms where the observation option is reasonable. The "observation option" is when a doctor waits 48 to 72 hours to give a child an antibiotic, and only uses medicine to relieve the child's symptoms in the meantime. The AAFP maintains that it's extremely important for the doctor and the parent or caregiver to keep up communication throughout the observation period in the event the child needs to be reevaluated for treatment.
  • Do not perform voiding cystourethrogram (VCUG) routinely in the first febrile (feverish) urinary tract infection (UTI) in children aged 2-24 months. A VCUG is an x-ray that is taken while the patient is urinating. The AAFP explains that the risk of radiation is more dangerous than the risk of not treating the child until they have their second UTI and are a little older.
  • Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam. There has been recent evidence that PSA-based testing has a high possibility of over-diagnosing prostate tumors. The AAFP explains that many tumors are often harmless, but the treatment can be very risky to a patients' health. Doctors should only offer or order this type of testing if the patient is 100 percent informed and in agreement.
  • Do not screen adolescents for scoliosis (curving of the spine). Thus far, there has been no reliable evidence that scoliosis can be detected any earlier through screening compared to not screening. The AAFP argues that screening could give false positive test results and that adolescents could be physically and psychologically harmed by unnecessary and excessive treatment.
  • Do not require a pelvic exam or other physical exam to prescribe oral contraceptive (birth control) medications. Evidence has shown that hormonal contraceptives are generally tolerated, safe and effective for the majority of women, therefore a pelvic or breast exam is not needed to prescribe them. The AAFP states that it is safe to prescribe hormonal contraceptives based on a patients' medical history and blood pressure measurement.

All guidelines were chosen after months of reviewing and considering the most current medical evidence.

This list was released on September 24 by the American Academy Of Family Physicians as part of Choosing Wisely: An Initiative of the American Board of Internal Medicine Campaign.

Review Date: 
September 27, 2013
Last Updated:
September 30, 2013