It’s time for another Choosing Wisely update!

(See previous blog posts: http://phcprimarycare.org/?p=101 and http://phcprimarycare.org/?p=346.)

As a refresher, Choosing Wisely was created “to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary”

To help guide this ideal, national specialty organizations were asked to develop five tests or procedures common to their field which need to be discussed and/or questioned. The results are the following lists: Five Things Physicians and Patients Should Question.

Choosing Wisely has partnered with many consumer organizations, such as AARP, Covered California, and Consumer Reports, to further disseminate this information in patient-friendly formats.

Most specialty societies have been involved, including in my own field of pediatrics. The American Academy of Pediatrics (AAP) had developed their “List of 5” previously and just recently added five more!

The original five:

1)    Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).

2)    Cough & cold medicines should not be prescribed or recommended for respiratory illnesses in children under 4 years of age.

3)    CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/PECARN criteria should be used to determine whether imaging is necessary.

4)    Neuroimaging is not necessary in a child with a simple febrile seizure.

5)    CT scans are not necessary in the routine evaluation of abdominal pain.

And the new quintet:

6)    Don’t prescribe high-dose dexamethasone (0.5mg/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in the pre-term infant.

7)    Don’t perform screening panels for food allergies without previous consideration of medical history.

8)    Avoid using acid blockers and motility agents such as metoclopramide for physiologic gastroesophageal reflux (GER) that is effortless, painless, and not affecting growth. Do not use medication in the so-called “happy-spitter.”

9)    Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.

10)   Infant home apnea monitors should not be routinely used to prevent Sudden Infant Death Syndrome (SIDS).

These lists should be more widely publicized, as I was not even aware of this initiative until I attended a recent conference where it was the focus. I know I have been guilty of #7 but am surprised about #10 as I haven’t seen a request for a home apnea monitor in probably a decade!

Given our increasingly complex and expensive health care system, these recommendations can certainly be an inroad to slowing down overuse of certain treatments and procedures.

Jeff Ribordy, MD

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