Friday, April 6, 2012
More medical adventures to skip - Part 1
To see the lists yourself, go to choosingwisely.org and click on the lists link on the top which provides more details than I can decipher. But here is a summary:
From the American Academy of Allergy, Asthma & Immunology: \
- Don't perform unproven diagnostic tests.
- Don't order sinus CT or indiscriminately prescribe antibiotics for sniffles
- Don't do routine diagnostic testing in patients with hives
- Don't recommend replacement immunoglobulin therapy for recurrent infections unless there are poor responses to vaccines.
- Don't diagnose or manage asthma without spirometry - in other words do not assume
American Academy of Family Physicians
- No imaging for low back pain in the first six weeks unless there are red flags
- Don't routinely prescribe antibiotics for a cold unless the symptoms last longer than 7 days or worsen
- Don't use DEXA screening for bone density in women under 65 or men under 70 with no risk factors
- Don't order EKG's for patients without symptoms
- No pap smears on women under 25 or who have had a hysterectomy for non-cancerous reasons.
American College of Cardiology
- No stress tests or advanced non invasive imaging in the intial evaluation of patients without cardiac symptoms unless high-risk markers are present
- No annual stress tests of advanced non-invasive imaging in routine follow up on patients with no symptoms
- Do cardia imaging or stress tests as a pre-operative assessment on patients as part of low-risk, non cardiac surgery
- No ECG as routine follow up for adult patients with no symptoms
- No stents unless specific criteria met - must meet the big word description that I don't understand.
American College of Physicians
- No stress tests on patients with no symptoms and who are not at risk for coronary heart disease.
- No imaging studies on patients with non-specific low back pain.
- No CT or MRI of brains unless symptoms are present.
- Use D-dimer measurement as initial diagnostic step for VTE and if negative, no more tests are needed.
- Skip the preoperative chest x-ray unless symptoms are present.
I see some repetition here. I bet many of these were ordered as a CYA move to prevent malpractice law suits based on recommendations from the doctor's insurers.