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Rhode Island State Employee Health Plan

Asking Better Questions Leads to Smarter Healthcare Choices


Choosing Wisely is a national campaign to help you and your doctors have important conversations about your healthcare and the pros and cons of too much care — or too little care.

Consumer Reports and the ABIM Foundation, the creators of Choosing Wisely, are working to encourage clinicians and patients to engage in more conversations about options in tests, treatments and procedures. These conversations can help increase the quality of your healthcare and decrease harm that is sometimes caused by overuse of medical testing and treatments.

Consumer Reports has created more than one hundred patient-friendly, easy-to-read and medically accurate Choosing Wisely materials to educate you about what care is best for you at that particular time, and when you may want to hold back. It all starts with the Choosing Wisely 5 Questions, listed below – consider taking them with you and trying them out next time you see your doctor.

  • Do I really need this test or procedure? Medical tests help you and your healthcare provider decide how to treat a problem. Medical procedures help to actually treat it.
  • What are the risks? Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
  • Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more.
  • What happens if I don’t do anything? Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
  • How much does it cost? Ask if there are less expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.


Choosing Wisely aims to promote conversations between patients and providers by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

To help patients engage their health care provider in these conversations and empower them to ask questions about what tests and procedures are right for them, Consumer Reports has developed patient-friendly materials based on medical specialty societies’ lists of recommendations.


As you will see in your further exploration of this website and other Choosing Wisely websites, the amount of material available for your review can be somewhat overwhelming.  To help narrow your focus and provide a basic introduction to Choosing Wisely, the State of Rhode Island Department of Administration’s Office of Employee Benefits, the office which oversees operation of the state employee health plan, has chosen these materials.

Choosing Wisely Health Guides for Patients and Families


Choosing Wisely helps doctors and patients together avoid needless and even harmful procedures.

The links at left will lead you through our collection of brochures.

Choosing Wisely: Tests

Allergy Tests (AAAAI)

If you don’t have symptoms or a medical evaluation that points to allergy, think twice about skin or blood tests.

Alzheimer’s Disease Testing (SNMMI)

If you’re having memory problems, your doctor should look for other causes before ordering a brain scan.

Blood Tests for Miscarriage Risk (SMFM)

Blood tests for thrombophilia often are not needed, even if you have had a pregnancy problem.

Blood Tests in the Hospital (SHM)

In the hospital, if your blood test results stay the same after a day or two, you may not need them again.

Cancer Tests and Treatments (ASCO)

Some tests, treatments, and procedures are not only unnecessary, they can even prove harmful.

Cervical Cancer Screening (ASCCP)

Young women with an abnormal Pap test don’t always need to be treated right away.

Echocardiography for Heart Valve Disease (ACC)

When do you need an echocardiogram?

EKGs and Exercise Stress Tests (AAFP)

EKGs or exercise stress tests usually aren’t necessary for people without symptoms.

Five Questions to Ask About Medical Tests Before Surgery (posters)

Talk to your doctor to make sure you end up with the right pre-op tests.

Five Ways to be Smart About Ovarian Cancer (posters)

What you need to know about ovarian cancer prevention, risks, symptoms and testing.

Health Checkups (SGIM)

You probably don’t need that yearly checkup. In fact, it can do more harm than good.

HIV: When You Need CD4 Tests (HIVMA)

If your treatment for HIV is working well, you usually need the CD4 count less often, if at all. Here’s why.

Imaging and Blood Tests in Early Breast Cancer (ASCO)

When do cancer experts recommend imaging tests and tumor marker tests?

Lab Tests Before Surgery (ASCP)

Most healthy people don’t need blood or urine tests done before surgery, especially low-risk surgery. Here’s why.

Lyme Disease Tests (ACR)

There are two blood tests for Lyme disease, but usually you don’t need them. Here’s why.

Making Smart Decisions About Genetic Testing (ACMG)

Sometimes a genetic test is not the best way to find an inherited condition or disease risk.

Medical Tests Before Eye Surgery (AAO)

Most people don’t need to have their blood tested or their heart checked before they have eye surgery. Here’s why.

Medical Tests Before Surgery

Often, pre-operative tests are not necessary. It is not a good idea to get them just because you’re having surgery.

Neck and Back Pain: When You Need Tests (AANEM)

If the symptoms are severe or continue for a while, you may need an electrodiagnostic test.

Pap Tests (AAFP)

Many teenage girls and some women have the test when they don’t need it. Here’s why.

PSA Test for Prostate Cancer (AAFP)

The PSA screening test is widely used, but often is not needed.

PSA Tests for Prostate Cancer (AUA)

The PSA test is the only available screening test for prostate cancer, but it can have serious risks.

Screening Tests for Ovarian Cancer (SGO)

Ultrasound and the CA-125 blood test are not useful for screening low-risk women for ovarian cancer.

Screening Tests: When You Need Them, When You Don’t

It’s important to know which tests you need, and how often you need them.

Spirometry for Asthma (AAAAI)

Many people who need the test don’t receive it.

Stress Tests After a Stent Procedure (SCAI)

Stress tests usually aren’t helpful after a stent procedure, unless you have symptoms of heart disease.

Stress Tests Before Surgery (SVM)

If you’re having surgery, you will probably not need a heart stress test beforehand if you are healthy, active, and feeling well, or if you’re having minor surgery.

Stress Tests for Chest Pain (ASNC)

If you’re at low risk for having a heart problem, even if you have symptoms, you usually don’t need this imaging test.

Testing After Heart Procedures (ASNC)

Unless you’re experiencing symptoms, this test usually isn’t helpful in the first few years after heart bypass surgery or a stent procedure.

Tests Before Heart Surgery (STS)

Before heart surgery, you probably don’t need a breathing test or carotid ultrasound test, unless you have breathing problems or symptoms.

Urinary Tract Infections in Older People (AGS, AMDA)

Older adults are often tested for UTIs. But if you don’t have symptoms, the tests are not very useful.

Vitamin D Tests (ASCP)

Doctors often order a blood test to measure your vitamin D, but the results are unlikely to change their advice.

Choosing Wisely: Imaging

Bone-Density Tests (AAFP)

If you’re not at higher risk for weak bones, you should think twice about the bone-density test. Here’s why.

Brain Scans for Head Injuries (AMSSM)

Brain scans are usually not helpful for a concussion.

Cardiac Imaging Stress Tests (ASNC)

In some cases, especially in healthy people without chest pain, you should be cautious about the tests.

Chest X-rays Before Surgery (ACR)

If you don’t have signs or symptoms of heart or lung disease, think twice about having a pre-operative X-ray.

Clogged Neck Arteries (AAFP)

Do you need a screening test for clogged neck arteries?

CMR Tests for Chest Pain and Cardiac Screening (SCMR)

CMR is an imaging test for heart disease. But it may not be the best test for you.

CT Scans for Children With Head Injuries (AAP)

For children with head injuries, a CT scan often is not needed.

CT Scans in the Emergency Department (ACEP)

They may not be needed as often as you think.

CT Scans to Find Lung Cancer in Smokers (CHEST/ATS)

The CT scan, used to look for early signs of lung cancer, is not useful for many smokers.

Do You Need a CT Scan for a Head Injury? (ACEP)

A health history and physical exam can help the doctor decide if you need a Computerized Tomography (CT) scan.

Echocardiogram Before Surgery (ASE)

If you’re having surgery, you may wonder if you need an echocardiogram first.

Echocardiography After Valve Surgery (STS)

Sometimes the echocardiogram imaging test is done very soon after heart valve surgery, while you are still in the hospital. Usually that’s not useful.

Echocardiography for Heart Valve Disease (ACC)

When do you need an echocardiogram?

Five Ways to be Smart About Back Pain (large poster)

Don’t rush to MRIs, CT scans or X-rays for back pain.

Five Ways to be Smart About Back Pain (small poster)

Don’t rush to MRIs, CT scans or X-rays for back pain.

Heart Imaging Before Surgery (ACC)

If you’re having surgery, you may wonder if you need a heart imaging test first to make sure it is safe.

Heart Imaging Tests Before Surgery (ASNC)

If you don’t have heart problems, you probably don’t need a heart test before an operation.

Heart Stress Tests Before Chest Surgery (STS)

Stress tests usually aren’t helpful if you don’t have heart problems.

Imaging and Blood Tests in Early Breast Cancer (ASCO)

When do cancer experts recommend imaging tests and tumor marker tests?

Imaging for Headaches (rack card)

Imaging tests usually don’t show why you’re having headaches, and they won’t ease your pain.

Imaging for Hearing Problems (AAO-HNSF)

For tinnitus or sudden hearing loss, imaging tests such as CT scans or MRIs can be unnecessary, costly, or even harmful.

Imaging Tests After a Heart Procedure (ACC)

If you’ve had bypass surgery or a stent inserted to open a blocked artery, do you need regular imaging tests?

Imaging Tests for Back Pain (AAFP)

It seems like getting an X-ray, CT scan or MRI to find the cause would be a good idea.

Imaging Tests for Early Prostate Cancer (ASCO)

It’s not always a good idea to get all the tests that are available. You may not need them.

Imaging Tests for Headaches (ACR)

Many with severe headaches want a CT scan or MRI to see if they have a tumor or other serious problem.

Imaging Tests for Heart Disease (ACC)

If you are a healthy person without symptoms, you should think twice about having these tests.

Imaging Tests for Ovarian Cysts (ACR)

Repetitive ultrasound exams may not be necessary.

Lower Back Pain (rack card)

Does your lower back hurt? You probably don’t need an MRI, CT scan, or X-ray.

PET Scans After Cancer Treatment (ASCO)

If you’ve been treated for cancer, you may not need PET scans to check for a return of the cancer.

Screening Tests for Brain Aneurysms (AANS)

Screening healthy people for weak areas in the brain’s blood vessels can do more harm than good.

When You Need a CT Scan to Check for a Blood Clot in Your Lungs (ACEP)

If you have most of the signs and risk factors for a blood clot in your lungs, it may be wise to have a CT scan. If not, you may receive a D-dimer blood test first.

Whole-Body Scans to Screen for Cancer (ACPM)

No medical society recommends whole-body scans. There is no evidence that they are a good screening tool.

Why the Doctor May Not Order a CT Scan for Kidney Stones (ACEP)

For most people, a urine test, blood test and health history are all that’s needed to diagnose kidney stones.

Choosing Wisely: Drugs

Antibiotic Treatment in the Hospital (SHEA)

The CDC is urging hospitals to cut back on the use of antibiotics when they are not needed. Here’s what you should know.

Antibiotics (rack card)

Have a sore throat, cough, or runny nose? You probably don’t need antibiotics.

Antibiotics (rack card) (for children)

Does your child have a sore throat, cough, or runny nose? They probably don’t need antibiotics.

Antibiotics for Ear Infections in Children (AAFP)

In most cases of middle ear infection, antibiotics are not needed. Here’s what to do instead.

Antibiotics for People With Catheters (AUA)

Almost all people who have catheters have some bacteria in their urine. But that doesn’t mean they all need antibiotics.

Antibiotics for Pink Eye (AAO)

Antibiotic eye drops or ointments don’t usually help with conjunctivitis. In fact, they can do more harm than good.

Antibiotics for Respiratory Illness in Adults (IDSA)

Antibiotics don’t help most respiratory infections. Here’s when you need antibiotics, and when you don’t.

Antibiotics for Respiratory Illness in Children (AAP)

Most of the time, children don’t need antibiotics for sore throat, cough or runny nose.

Antibiotics for Urinary Tract Infections in Older People (AGS)

Many older people get antibiotic treatment for urinary tract infections when they don’t need it.

Antibiotics for Your Skin (AAD)

Some skin problems don’t stem from infections at all. So treating them with antibiotics can do more harm than good.

Antibiotics: When You Need Them and When You Don’t

When and how to use antibiotics to help you and your loved ones avoid drug resistance.

Antibiotics: Will They Help You or Hurt You?

Do you really need antibiotics? They can help you. But they also can harm you.

Antipsychotic Drugs for People with Dementia (AGS)

Powerful antipsychotic drugs should not be the first choice for people with dementia. Here’s why.

Avoid Opioids for Most Long-Term Pain

In this guide you can read what the experts say about using opioids.

Cholesterol Drugs for People Over 75 (AMDA)

If you are age 75 or older and you haven’t had symptoms of heart disease, statins may be a bad idea.

Choosing Wisely: Antibiotics (Video)

Antibiotics can help with some infections, but they’re not right for every situation.

Diabetes Tests and Treatments

If you have diabetes, when do you need to test your own glucose levels, and when do you need to take medication?

Dietary Supplements to Prevent Heart Disease or Cancer (ACPM)

Research shows that most people don’t benefit from taking supplements to prevent heart disease or cancer.

Drugs for Migraine Headaches (AAN)

Think twice about treating migraine attacks with opioids or butalbital.

Drugs for Rheumatoid Arthritis (ACR)

The older, “non-biologic” drugs are a better first choice for treating rheumatoid arthritis.

Drugs to Prevent Infection During Chemotherapy (ASCO)

When do you need CSFs? When don’t you need them?

Five Questions to Ask Your Doctor About Antibiotics (large posters, for children)

Use these five questions to talk to your doctor about when you need antibiotics — and when you don’t.

Five Questions to Ask Your Doctor About Antibiotics (small posters, for children)

Use these five questions to talk to your doctor about when you need antibiotics — and when you don’t.

Medicines to Relieve Chronic Pain (ASA)

Opioids (narcotics) usually are not the best way to treat long-term pain like arthritis, back pain or headaches.

Medicines to Treat Cancer (ASCO)

Drugs used to treat cancer can also cause harm, and some are very expensive. Here’s what to discuss with your doctor.

Opioids for Pain (rack card)

Do you have ongoing pain that is not from cancer or a terminal illness? If so, you probably don’t need an opioid pain reliever.

Oral Antibiotics for Ear Infections (AAO-HNSF)

Sometimes antibiotic eardrops are safer and more effective than oral antibiotics.

Painkiller Choices With Kidney or Heart Problems (ASN)

If you suffer from high blood pressure, heart failure, or kidney disease, steer clear of some pain relievers.

Preventing Seizures After an Ischemic Stroke (AANS, CNS)

Anti-seizure medicine is not usually necessary after an ischemic stroke.

Sleeping Pills for Children With Insomnia (AASM)

Sleep drugs aren’t made for children. There are no prescription drugs approved in the U.S. to treat childhood insomnia.

Sleeping Pills for Insomnia (AASM)

Sleeping pills are often not the best option for insomnia. Here’s what you need to know.

Sleeping Pills for Insomnia and Anxiety in Older People (AGS)

Older adults usually should try other non-drug treatments first, for insomnia and anxiety.

Supplements for Osteoarthritis (AAOS)

The popular supplements glucosamine and chondroitin sulfate do not help relieve arthritic knees.

Taking Medicines Safely (ASHP)

It is more precise to measure medicines in milliliters, instead of using a kitchen spoon.

Testosterone for Erection Problems (AUA)

Unless you have other symptoms of low testosterone, you should think twice about the treatment. Here’s why.

Think Your Child Needs Antibiotics?

Taking antibiotics when they aren’t needed can cause dangerous side effects.

Treating Frequent Headaches With Pain Relievers (AHS)

It is easy to use too much pain medicine. This can make headaches worse and cause other medical problems.

Treating Heartburn and GERD (AGA)

In most cases of heartburn a PPI isn’t necessary.

Treating Sinusitis (AAAAI)

Millions of people are prescribed antibiotics each year for sinusitis.

Treating Sinusitis (AAFP)

Millions of people are prescribed antibiotics each year for sinusitis.

Treating Sleep Problems (APA)

If you have insomnia, antipsychotic drugs should not be the first choice of treatment.

You May Not Need Antibiotics for Your Skin (AAD)

You may not need antibiotics for some skin problems. Ask your doctor if there is another treatment you can try instead.

Choosing Wisely: Procedures

Advice for Caregivers: Treatments and Tests for Seniors

Some tests and treatments won’t help older adults. They may even be harmful, especially near the end of life.

Artery and Vein Problems (SVS)

Vascular surgeons have listed four overused operations that are intended to treat vein and artery problems. If your doctor orders one of these, you should ask why.

Ask Your Doctor: Do I Need This Cancer Test or Treatment? (ASCO)

You may not need some common forms of imaging, screening tests, monitoring and drug therapy for cancer.

Back Pain Tests and Treatments (AAPM&R)

Some tests and treatments for back pain may not be right for you. That’s why it is important to talk to your doctor.

Bed Rest for Lower-Back Pain (NASS)

Studies show that staying in bed longer than 48 hours won’t help with lower-back pain.

Blood Transfusions for Anemia in the Hospital (ASH)

Anemia is usually not urgent. Usually you don’t need a lot of blood. Or you may not need any blood at all.

Breast Biopsy (CoC)

In contrast with surgical or “open” biopsy, a needle biopsy is easier on the body.

Cancer Tests and Treatments (ASCO)

Some tests, treatments, and procedures are not only unnecessary, they can even prove harmful.

Care at the End of Life for Advanced Cancer Patients (ASCO)

Although it is hard to accept, the best thing for you may be to stop treatment for the cancer.

Carotid Artery Surgery (AAN)

Having some blockage in a carotid artery doesn’t automatically mean you should have artery-clearing surgery.

Colonoscopy (AGA)

Even a very good test can be done too often.

Dental Fillings That Contain Mercury (ACMT, AACT)

It’s not necessary to replace fillings that contain mercury.

Do You Really Need That Medical Test or Treatment? (rack card)

Sometimes doctors recommend things that aren’t needed. Sometimes they do it because their patients expect and ask for them. Before you get any medical test or treatment, ask your doctor these 5 questions.

Early Delivery (ACOG, AAFP)

To hurry a baby’s birth can increase the risk of serious problems for both you and your baby.

Feeding Tubes for People With Alzheimer’s (AGS, AAHPM)

Feeding tubes sometimes do more harm than good. Here’s why.

Five Physical Therapy Treatments You Probably Don’t Need (APTA)

Five common physical therapy treatments can lead to harm, more tests, and greater costs.

Home Apnea Monitors for SIDs (AAP)

Home apnea monitors give little or no protection from Sudden Infant Death Syndrome.

Home Oxygen After a Hospital Stay (CHEST/ATS)

Many people who use long-term home oxygen therapy don’t need it.

Hospital Hazards (AAN)

The American Academy of Nursing has identified four hospital practices that are usually unnecessary and may harm you.

Immunoglobulin Replacement Therapy (AAAAI)

Some people receive the treatment even though they don’t need it.

Implanted Heart Devices at the End of Life (AAHPM)

An ICD helps the heart beat normally. But if you are near death, those shocks can make things worse.

Kidney Disease (ASN)

Here are four important tests and treatments you should carefully discuss with your family and doctor

Managing Side Effects of Cancer and its Treatments (AAN)

Some methods used to manage symptoms and side effects do not work. And some proven methods are often overlooked.

Monitoring Your Baby’s Heartbeat During Labor (AAN)

During labor and birth, the type of fetal heart rate monitoring called IA, for intermittent auscultation, is often the better choice.

Overactive Bladder and Pelvic Organ Prolapse (AUGS)

Here’s what women should know about tests and treatments for these conditions.

Palliative Care (AAHPM)

With palliative care, you can get physical, emotional, and spiritual support at any stage of a serious illness.

Pelvic Exams and Pap Tests Before Contraceptives (AAFP)

You usually don’t need a Pap test and pelvic exam before getting birth control pills.

Preventing Infections in the Hospital (SHM)

Watch out for two overused hospital medical practices, urinary catheters and ulcer drugs.

Questions to Ask Your Doctor About Radiation for Cancer (ASTRO)

Radiation therapy can help treat cancer and the painful symptoms from tumors. But it’s not always needed.

Radiation Therapy for Breast and Gynecologic Cancers (ASTRO)

When it comes to radiation therapy, sometimes less is more. Use this advice to start a conversation with your doctor about the benefits and risks.

Radiation Therapy for Cancer (ASTRO)

Here is advice for talking with your doctor about whether to use radiation as part of cancer treatment.

Sentinel Node Biopsy for Breast Cancer (CoC, NAPBC)

If you have breast cancer, there is a newer, simpler surgery to check your lymph nodes.

Stable Heart Disease (SCAI)

You may not need an angiogram if your heart disease is stable. Here’s why.

Tests and Treatments Employees May Not Need (ACOEM)

Employers should consider these guidelines when sending workers or job candidates to the doctor.

Tests and Treatments for Prostate Cancer

It can be hard to know which tests and treatments to get for prostate cancer. This report pulls together the latest advice from experts.

Tests and Treatments for Women with Breast Cancer (ASBS)

If your doctor recommends one of these five procedures, ask if it’s really necessary. And ask about the risks and costs.

Treating Acute Blood Clots (ASH)

If you have a deep blood clot, you probably don’t need a device called an IVC filter. They don’t work better than blood-thinning drugs.

Treating Blocked Leg Arteries (SVM)

Most people with Peripheral Artery Disease won’t benefit from surgery or angioplasty.

Treating Low-Risk Prostate Cancer (ASTRO)

If you have prostate cancer, but it poses a low risk to you, consider “watchful waiting.”

Treating Plantar Fasciitis (AOFAS)

Some doctors recommend surgery. But that can lead to complications, and it doesn’t always work.

Treatments and Tests Your Baby May Not Need in the Hospital (AAP)

Here are some common tests and treatments a premature baby may not need.

Unnecessary Treatments in the Emergency Room (ACEP)

Three procedures commonly used in the emergency room are unnecessary in many cases.

Vision Care for Children (AAPOS)

There are several common vision tests and procedures that many children do not need.

When It’s Hard to Get Pregnant (ASRM)

Some fertility tests are not usually needed. For example, most couples don’t need laparoscopies or post-coital tests.

Which Dental Treatments Are Right for You? (ADA)

Here are some facts about common dental treatments. Ask your dentist which treatments are best for you and your family.

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Choosing Wisely Video Collection

Our video collection reinforces the messages from Choosing Wisely and Best Buy Drugs. You can watch them here, share them, or view the entire collection.

These special reports from Consumer Reports magazine address important issues confronting healthcare consumers and their families.

Each PDF file may be read here, printed or downloaded to the user’s own device.

10 Over-the-Counter Drugs to Avoid During Pregnancy

We’ve identified 10 common ingredients used in OTC drugs that are risky for pregnant women, as well as safer alternatives.

9 Great Health Articles Worth Reading Again

A special compilation of highlights of our recent work in health at Consumer Reports.

America’s Antibiotic Crisis

Consumer Reports has joined the fight to keep a unique and life-saving product working: antibiotics.

Cancer Tests and Treatments

When you need that cancer screening test — and when you don’t.

Dr. Who?

The next ‘doctor’ you see might be a nurse practitioner. Here’s a guide to who you can expect to see in a white coat, and how they can help you.

Healing Hearts

Cardiac care is a money-making machine that too often favors profit over science.

Medical Homes

Patient-centered medical homes seek to provide comprehensive, continuous, well-coordinated care to patients.

What Doctors Wish Their Patients Knew

How to strengthen the doctor-patient relationship.

What to Reject When You’re Expecting

Here are 10 procedures to think twice about during your pregnancy.