Saturday, April 7, 2012

The rest of the medical adventures to skip - Part 2

More from choosingwisely.org on medical adventures to skip:

American College of Radiology:
- No imaging for uncomplicated headaches - just take a damn aspirin will you.
- No imaging for suspected pulmonary embolism without moderate or pre-test probability
- No preop or preadmission chest x-rays for ambulatory patients without history
- No CTs for evaluation in appendicitis until an ultrasound has been considered.
- No follow up imaging for inconsequential cysts unless over 1 cm

American Gastroenterological Association
- Translator needed for this one but I believe it means don't over medicate for GERD: For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals.
- Colonoscopies only once every ten years if clean
- Colonoscopies not repeated for at least five years who have small polyps that were removed during a colonoscopy.
- Do not repeat endocscopy for at least 3 years with Barretts esophagus patients without cellular changes.
- CT scans do not need to be repeated for abdominal pain unless clinical findings or symptoms

American Association of Nephrology
- Skip routine cancer screenings for dialysis patients with limited life expectancies who are asymptomatic
- No ESAs to reach normal hemoglobin levels in chronic kidney disease patients
- No NSAIDs to patients with hypertension, heart failure or CKD.
- No PICC lines in Stage III-V CKD patients without consulting a nephrologist.
- Consult patients, families and physicians before starting chronic dialysis - a group decision

American Society of Nuclear Cardiology
- No stress tests or coronary angiography on patients without cardiac symptoms unless high risk markers are present
- no cardiac imaging for patients who are at low risk
- No radionuclide imaging as part of routine follow up in asymptomatic patients.
- No preoperative cardiac imaging as preoperative assessment in patients before  low or medium risk non cardiac surgery
- Reduce radiation exposure in cardiac imaging tests including not performing tests when limited benefits are  likely

After having read all these (and written them down) my thoughts are I am happy to see these recommendations. If there is no need, why are they running the tests? Just because a new test comes along and it shows some benefit, if over time, the becomes proven that there is no real benefit, why do we keep running it? If a patient has no symptoms why do they need a test?  We have all been trained by our doctors to expect test after test or magic pill after magic pill. But maybe just go take an aspirin and wait a few days. And a headache doesn't mean its a brain tumor.

Juggling the patient's peace of mind vs. costs vs. over diagnosis can be difficult but if in the long run there is no real benefit, feel free to skip my tests, thank you.

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