“But most of these recommendations To do or not to do?
Nine physician specialty societies, and more to come, joined the Choosing Wisely campaign (
http://choosingwisely.org) in identifying their “Top Five” commonly used tests and proce- dures they say are often unnecessary. A sampling of the recommendations is below. Patients can see consumer-friendly versions of the latest
lists at
www.consumerhealthchoices.org/campaigns/choosing- wisely/.
• Don’t order sinus computed tomography or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis. (American Academy of Allergy, Asthma & Immunology)
• Don’t use dual-energy x-ray absorptiometry screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors. (American Academy of Family Physicians)
• Don’t perform stress cardiac imaging or advanced noninva- sive imaging in the initial evaluation of patients without car- diac symptoms unless high-risk markers are present. (Ameri- can College of Cardiology)
• Don’t obtain imaging studies in patients with nonspecific low back pain. (American College of Physicians)
• Don’t do imaging for uncomplicated headache. (American College of Radiology)
• For pharmacological treatment of patients with gastroesoph- ageal reflux disease, long-term acid suppression therapy (proton pump inhibitors or histamine 2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals. (American Gastroenterological Association)
• Don’t use cancer-directed therapy for solid tumor patients with these characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment. (American Society of Clinical Oncology)
• Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms. (American Society of Nephrology)
28 TEXAS MEDICINE December 2012
are not news to people,” he said. “The reason to focus on them is they re- main commonly done, despite common knowledge that they are frequently un- necessary. And a lot of that is due to phy- sicians’ perception of what patients want or demand that they believe is in their best interest, but is quite often not.” Low back pain, for example, is a top complaint physicians hear. Yet in a vast majority of cases, the cause is hard to identify, and imaging does not offer a better idea of how to treat it than does a physical examination. That test could add not only unnecessary expense, but also unnecessary x-ray exposure. Dr. Stream says Choosing Wisely is “as much a patient safety initiative as anything else.” At the same time, because it is ulti- mately patients’ health at stake, the cam- paign recognizes that they, too, must be actively engaged in the decision-making process. Choosing Wisely partnered with well- known consumer groups like Consumer Reports, for example, which is charged with translating and presenting the medical lists in ways that patients can understand and making them available in easy-to-read brochures, consumer publications, and on various websites, including Wikipedia. Having information like these lists in advance or at the point of care can help ease those discussions if both doctors and patients have the same information, Dr. Stream says. “This tells your patients that you really are doing the best pos- sible thing for them, and you are caring more and practicing good medicine, in- stead of the reverse.”
Anything that gets physicians and patients to discuss the best treatment
“without the government, or insurance companies, or attorneys dictating what’s to be done is a very good thing, and this campaign does that,” Dr. Strate said. More patient responsibility also could translate to less liability for doctors, she added.
Staying on target But physicians also remain wary that the lists themselves may be misused.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68