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Doctors identify 90 more tests and treatments that patients should question

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CT scans, which are currently given to half of all children who show up in an emergency room with a head injury, expose the child to high levels of radiation.

On Thursday, as part of the ongoing “Choosing Wisely” campaign, 17 leading medical specialty groups released 90 common tests and treatments whose routine use is not supported by good medical evidence.

“Choosing Wisely” is an initiative launched by the American Board of Internal Medicine Foundation in conjunction with Consumer Union‘s Consumer Reports.

Its goal, according to its founding organizations, “is to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources in the United States.”

Last April, nine medical groups identified 45 different common tests that doctors and patients should question. The new lists build on that earlier advice. Here is a sampling:

  • Don’t perform EEGs (electroencephalography) on patients with recurrent headaches. EEGs do not improve outcomes, but they do increase costs. (American Academy of Neurology)
  • Don’t induce labor or perform a cesarean section before a woman reaches her 39th week of pregnancy unless there is a strong medical reason for doing so. Early delivery is associated with an increased risk of learning disabilities and medical complications. (American Academy of Family Physicians and American College of Obstetricians and Gynecologists)
  • Don’t perform routine annual Pap tests on women between the ages of 30 and 65. In this age group, screening every three to five years is enough. (American College of Obstetricians and Gynecologists)
  • Don’t delay palliative (hospice) care for patients with a serious illness just because they are still receiving treatment for the illness. (American Academy of Hospice and Palliative Medicine)
  • Don’t give antibiotics to children or adults with pink eye (adenoviral conjunctivitis). Pink eye is a viral not a bacterial infection. (American Academy of Ophthalmology)
  • Don’t treat children under age 4 with cough and cold medicines. Such medicines offer no benefits but can have potentially serious side effects. (American Academy of Pediatrics)
  • Don’t routinely screen for vitamin D deficiency. Reserve such screening for people who have a significant risk factor (such as diagnosed osteoporosis or chronic kidney disease) and who may, therefore, need aggressive vitamin D therapy. (American Society for Clinical Pathology)
  • Don’t order chest X-rays for children with uncomplicated asthma or bronchiolitis. Such testing is not needed to determine treatment. (Society of Hospital Medicine)
  • Don’t use urinary catheters in non-critically ill patients simply because the patient is incontinent or because doing so is convenient for hospital staff. Catheters increase the risk of serious and even life-threatening infections. (Society of Hospital Medicine)
  • Don’t automatically give a CT (computed tomography) head scan to child with a minor head injury. Such scans, which are currently given to half of all children who show up in an emergency room with a head injury, expose the child to high levels of radiation. Children first should be observed for symptoms.  (American Academy of Pediatrics)
  • Don’t use opioids or butalbital treatment to relieve the pain of migraines, unless all other treatments fail. These treatments can actually worsen headaches, and opioids carry the risk of addiction. (American Academy of Neurology)

You can download all the lists from the medical specialty groups — along with the explanations of why the different tests and procedures made each list — at the “Choosing Wisely” website.

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