Friday, April 6, 2012

More medical adventures to skip - Part 1

More medical specialty societies have created lists of "Five things Physicians and Patients Should Question" - Thank God I found a copy of this list that was NOT in the format of a list of pictures and graphics so we don't have to read. The media believes that the average American can't read and needs lists of things and images to flip through so we can understand what they are saying (One of my new pet peeves - write down letters and words instead of pictures - I don't even need to run my finger under each line to follow along, nor do I sound the words out as I read. We are also so stupid we need to have the same stories over and over again reported down to a microscope level long after we couldn't care less any more.)

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.

More tomorrow

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