Five Things Physicians and Patients Should Question

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Five Things Pathologists, Laboratory Professionals
and Patients Should Question

The American Society for Clinical Pathology (ASCP) list was developed under the leadership of the chair of ASCP’s Institute Advocacy Committee and Past President of ASCP, Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance.

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Don't perform population based screening for 25-OH-Vitamin D deficiency.

Vitamin D deficiency is common in many populations, particularly in patients at higher latitudes, during winter months and in those with limited sun exposure. Over the counter Vitamin D supplements and increased summer sun exposure are sufficient for most otherwise healthy patients. Laboratory testing is appropriate in higher risk patients when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections, obese individuals).


Don't perform low risk HPV testing.

National guidelines provide for HPV testing in patients with certain abnormal Pap smears and in other select clinical indications. The presence
of high risk HPV leads to more frequent examination or more aggressive investigation (e.g., colposcopy and biopsy). There is no medical
indication for low risk HPV testing (HPV types that cause genital warts or very minor cell changes on the cervix) because the infection is not
associated with disease progression and there is no treatment or therapy change indicated when low risk HPV is identified.


Avoid routine preoperative testing for low risk surgeries without a
clinical indication.

Most preoperative tests (typically a complete blood count, Prothrombin Time and Partial Prothomboplastin Time, basic metabolic panel and
urinalysis) performed on elective surgical patients are normal. Findings influence management in under 3% of patients tested. In almost all
cases, no adverse outcomes are observed when clinically stable patients undergo elective surgery, irrespective of whether an abnormal test
is identified. Preoperative testing is appropriate in symptomatic patients and those with risks factors for which diagnostic testing can provide
clarification of patient surgical risk.


Only order Methylated Septin 9 (SEPT9) to screen for colon cancer
on patients for whom conventional diagnostics are not possible.

Methylated Septin 9 (SEPT9) is a plasma test to screen patients for colorectal cancer. Its sensitivity and specificity are similar to commonly
ordered stool guaiac or fecal immune tests. It offers an advantage over no testing in patients that refuse these tests or who , despite aggressive
counseling, decline to have recommended colonoscopy. The test should not be considered as an alternative to standard diagnostic procedures
when those procedures are possible.


Don't use bleeding time test to guide patient care.

The bleeding time test is an older assay that has been replaced by alternative coagulation tests. The relationship between the bleeding time
test and the risk of a patient's actually bleeding has not been established. Further, the test leaves a scar on the forearm. There are other
reliable tests of coagulation available to evaluate the risks of bleeding in appropriate patient populations.

Download and/or print this list to start the conversation with your patients.

While ASCP has taken a bold step in identifying and developing this list, our work does not stop here. Over the coming months and years, ASCP will be working with the ABIM Foundation, Consumer Reports, and a variety of Choosing Wisely campaign stakeholders to raise awareness of these lists and make them accessible to patients and the public. While the items on the lists are crucial and should be discussed between doctors and patients, the most important aspect of the effort is the conversation itself.

Learn more about Choosing Wisely and read all 26 lists released to date at