This is important reading if you’re a doctor.

And maybe of some interest even if you’re not.

Following this year’s successful launch of the Choosing Wisely Australia campaign by NPS Medicinewise, we have produced a second round of recommendations about unnecessary tests, treatments and procedures.

I chair the RACGP working group, and we have just shortlisted the  fifteen items shown below. Yesterday we sent the list to all RACGP members for a ‘top five’ vote, although many wanted to vote for all 15!

This is part of the important conversation among doctors and patients that sometimes, less is more. Over-testing and over-treating can harm patients both directly, and also by robbing time and resources that would be better spent on things that are actually helpful.

No surprise if some items are a tad controversial – we have deliberately focused on tests and treatments that are commonly used by Australian doctors.

Screening

1. Don’t routinely perform a pelvic examination when doing a Pap smear or prescribing an oral contraceptive
2. Don’t advocate screening mammography in women < 50 yo or > 74, unless high-risk
3. Don’t order colonoscopy as screening test for bowel cancer in the 98% of population where faecal occult blood testing (FOBT) is recommended

Imaging

4. Don’t order shoulder imaging for straightforward shoulder pain, unless surgery is being contemplated
5. Don’t order knee ultrasounds, nor ankle ultrasounds (except for achilles)
6. Don’t order pregnancy dating scans unless there is doubt about a woman’s dates
7. Don’t order chest x-rays for acute bronchitis unless bacterial pneumonia is suspected and the CXR will alter your management

Pathology

8. Avoid unnecessary screening tests in pregnancy. Unless targeted reasons, don’t order ELFT, thalassaemia screen, full iron studies [ferritin alone is more useful], toxoplasma or listeria
9. Don’t screen thyroid function on a healthy population
10. Don’t order herpes simplex serology

Treatment

11. Don’t routinely tick ‘no brand substitution’ on prescriptions. Exceptions may include; specific patient preferences or potential confusion
12. Don’t treat otitis media with antibiotics, in non- Indigenous children aged 2-12y, where reassessment is a reasonable option
13. Don’t treat osteoporosis without doing a fracture risk assessment, and explaining risk-benefit to the patient in absolute terms
14. Don’t use antipsychotics in older patients for insomnia or dementia, without regular reviews that consider deprescribing
15. Don’t recommend chelation therapy except for documented metal intoxication, diagnosed using validated tests in appropriate biological samples

Further recommendations:

Click here to see the list of 28 items we considered for the first round of recommendations earlier this year. Five made the final cut.