From the National Physician’s Alliance:
Top 5 Internal Medicine
* Lower Back Pain: Don’t do imaging for lower back pain within the first 6 weeks unless red flags are present.
* Screening: Don’t obtain blood chemistry panels (eg, basic metabolic panel) or urinalyses for screening in healthy adults who don’t have symptoms.
* EKGs: Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms.
* Cholesterol Lowering Drugs: Use only generic statins when initiating lipid-lowering drug therapy.
* Bone Density: Don’t use DEXA (bone density) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.
Top 5 Pediatrics
* Throat Infections: Don’t prescribe antibiotics for pharyngitis (sore throat) unless the patient tests positive for streptococcus (Strep throat). [According to an article in Time, “Most cases of sore throat are viral, yet antibiotics are prescribed more than half the time, contributing to drug resistance and high costs.”
* Head Injuries: Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors [The risks of radiation exposure for kids far outweigh any benefits of scanning otherwise]
* Fluid in the Middle Ear: Don’t refer otitis media with effusion early in the course of the problem. [Again, most ear infections are viral and will go away on their own without antibiotics.]
* Cold Medications: Advise patients not to use cough and cold medications. [Recent studies have shown that these medications have no benefit and parents often use incorrect dosages, leading to harmful side-effects.]
* Asthma: Use inhaled corticosteroids (a steroid medication) to control asthma appropriately.
Top 5 Family Medicine
* Lower Back Pain: Don’t do imaging for lower back pain within the first 6 weeks unless red flags are present.
* Sinusitis: Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis (inflammation of the sinuses) unless symptoms – which must include purulent (full of pus) nasal secretions AND maxillary (upper jaw bone) pain or facial or dental tenderness to percussion – last for 7 days OR symptoms worsen after initial clinical improvement. [The Time piece notes; “Despite the fact that most sinusitis is caused by a viral infection, antibiotics are still prescribed in more than 80% of outpatient cases. That adds up: each year sinusitis results in 16 million office visits and $5.8 billion in costs, even though viral infections will clear on their own.”]
* EKGs: Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms.
* Pap smears: Don’t perform Pap tests on patients younger than 21 years or in women have had a hysterectomy for benign disease.
* Bone scans: Don’t use DEXA (bone density) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.
