Thirteen things physicians and patients should question

There are certain medical practices that are followed routinely over a period of time though they may have lost their relevance at that particular point of time. All such practices should be discontinued and prescribing doctors should ask questions before indulging in such practices. Under choosing wisely campaign they are pointed out so that they may be stopped if the practising physician deems fit. College of Family Physicians of Canada has enumerated these practices which should be questioned before adoption. Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care.

• Don’t do imaging for lower-back pain unless red flags are present. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes.

• Don’t use antibiotics for upper respiratory infections that are likely viral in origins, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration. Bacterial infections of the respiratory tract, when they do occur, are generally a secondary problem caused by complications from viral infections such as influenza. Not only are antibiotics rarely indicated for upper respiratory illnesses, but some patients experience adverse effects from such medications.


• Don’t order screening chest X-rays and ECGs for asymptomatic or low-risk outpatients. There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. Chest X-rays for asymptomatic patients with no specific indications for the imaging have a trivial diagnostic yield, but a significant number of false-positive reports.


• Don’t screen women with Pap smears if under 21 years of age or over 69 years of age. The potential harm from screening women younger than 21 years of age outweighs the benefits and there is little evidence to suggest the necessity of conducting this test annually when previous test results were normal.
  


• Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient. There is little evidence to indicate there is value in routine blood tests in asymptomatic patients; instead, this practice is more likely to produce false-positive results that may lead to additional unnecessary testing.


• Don’t routinely measure Vitamin D in low-risk adults.


• Don’t routinely do screening mammography for average-risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in this age group.


• Don’t do annual physical exams on asymptomatic adults with no significant risk factors.


• Don’t order DEXA (Dual-Energy X-ray Absorptiometry) screening for osteoporosis on low-risk patients.


• Don’t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits.


• Don’t order thyroid function tests in asymptomatic patients.


• Don’t continue opioid analgesia beyond the immediate postoperative period or other episodes of acute, severe pain.


• Don’t initiate opioids long-term for chronic pain until there has been a trial of available non-pharmacological treatments and adequate trials of non-opioid medications.