Don’t Do This:

Annual physicals, antibiotics for bronchitis, sinusitis and ear infections, bone density tests at menopause, rectal exams for cancer screening, EKG’s and stress tests in asymptomatic patients, any cancer screening in elderly patients – the list of things doctors do routinely that are not supported by evidence seems to be growing exponentially, but how many doctors are changing their behavior, and how many patients are balking at the new definitions of what constitutes good health care?

Many of the recommendations have been around for along time, but doctors often ignore them, thinking that such guidelines are for the masses, but high quality, personalized care can be achieved by going beyond them. It can be a bitter pill to swallow that we are actually causing harm by being thorough.

I am reminded of a young cardiologist at the hospital where I did my residency. He demonstrated what it is like to have a treadmill stress test at a hospital health fair, and there were EKG abnormalities suggesting coronary artery disease. His older colleagues told him it was probably just a false positive test, but he insisted on having a cardiac catheterization. Toward the end of the procedure, which was normal, he developed ventricular fibrillation and almost died. Fortunately, he was resuscitated successfully, but that story has stayed in my memory ever since.

The “Choosing Wisely” website has an interesting collection of lists by each specialty society with things its members used to believe in that have now fallen out of favor.

http://www.choosingwisely.org/doctor-patient-lists/