Family Physicians: Choose Wisely and Stop Injudicious EKGs

Eduardo Sanchez, MD, deputy chief medical officer at the American Heart Association (AHA), says Choosing Wisely can be a useful tool for physicians and an empowering resource for patients.

"This isn't people telling docs what to do. This is docs looking at their own practices and saying, 'This is what we need to do differently,'" he said.

Choosing Wisely is a national initiative that promotes dialogue among physicians and patients about whether certain tests and treatments are necessary. Dozens of national specialty societies have identified tests and procedures commonly used in their fields and have come up with a list of procedures physicians and patients should question. For more information about the lists, visit

Dr. Sanchez says an important item on the Choosing Wisely list from the American Academy of Family Physicians (AAFP) is not ordering regular electrocardiograms (EKGs), which are used to detect underlying heart conditions, for low-risk patients. 

According to Choosing Wisely, "Potential harms of this routine annual screening exceed the potential benefit." The campaign goes on to say little evidence shows that detection of coronary artery stenosis in patients at low risk for coronary heart disease improves health outcomes, and false-positive EKGs can yield harm through unnecessary invasive procedures, overtreatment, and misdiagnosis. 

"An EKG doesn't give you very useful information," Dr. Sanchez said. 

Instead, he suggests that family physicians perform much simpler tasks, such as checking the patient's blood pressure and body mass index and asking the patient about his or her physical activity to get a more accurate reading of underlying heart conditions.

Dr. Sanchez says an individual EKG is not a lofty expense, but when EKGs are performed regularly for patients who don't likely need it, the cost adds up.

"It's about understanding the opportunity of redirecting efforts to things that make sense," he said. Dr. Sanchez notes the importance of the Choosing Wisely partnership with Consumer Reports, which provides resources for patients on many of the procedures addressed in the campaign. "EKGs and exercise stress tests," available at, is an online resource patients can use to evaluate whether an EKG is necessary.

"It can be empowering as well as informative for the patient," Dr. Sanchez said of the Choosing Wisely campaign.

Other recommendations on the AAFP's Choosing Wisely list are:

Don't do imaging for low back pain within the first six weeks, unless red flags are present.

Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days or symptoms worsen after initial clinical improvement.

Don't use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.

Don't perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.

More recommendations for family physicians produced in the second and third phases of the Choosing Wisely campaign can be found at 


Texas Medicine, Jan. 2015

Last Updated On

May 13, 2016

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