and patients should question
stenosis in asymptomatic patients at low risk for coronary
heart disease improves health outcomes. False positive
tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Chest Xrays for asymptomatic patients with no specific indications
for the imaging have a trivial diagnostic yield, but a significant number of false positive reports. Potential harms of
such routine screening exceed the potential benefit.
4
Don’t screen women with Pap smears if
under 21 years of age or over 69 years of
age.
•
Don’t do screening Pap smears annually in women
with previously normal results
• Don’t do Pap smears in women who have had a hysterectomy for non-malignant disease
The potential harm from screening women younger than
21 years of age outweighs the benefits and there is little
evidence to suggest the necessity of conducting this test
annually when previous test results were normal. Women
who have had a full hysterectomy for benign disorders no
longer require this screening. Screening should stop at age
70 if three previous test results were normal.
5
Don’t do annual screening blood tests unless directly indicated by the risk profile of
the patient.
may lead to additional unnecessary testing. The decision to
perform screening tests, and the selection of which tests to
perform, should be done with careful consideration of the
patient’s age, sex and any possible risk factors.
How the list was created
The Canadian Medical Association’s (CMA) Forum on General and Family Practice Issues (GP Forum) is a collective of
leaders of the General Practice sections of the
provincial and territorial medical associations. To establish
its Choosing Wisely Canada Top 5 recommendations, each
GP Forum member consulted with their respective GP
Section members to contribute candidate list items. Items
from the American Academy of Family Physicians’ Choosing Wisely® list were among the candidates. All candidate
list items were collated and a literature search was conducted to confirm evidence-based support for the items.
GP Forum members discussed which of the thirteen items
that resulted should be included. Agreement was found
on eight of them. Family physician members of the CMA’s
e-Panel voted to select five of the eight items. These five
items were then approved by the provincial and terr