You know it's going to be a bad day when your most challenging patient comes into your office with the list of "45 most dubious tests and therapies." Recently, nine American specialty societies each identified five procedures, tests, or treatments that are routinely used but may not always be necessary.
Among the recommendations: Don't take a "routine" pre-op chest x-ray if the patient has an "unremarkable" history and physical exam. Don't do a cardiac stress test or treadmill on a patient who has no cardiac symptoms or other significant risk factors for coronary artery disease. Don't routinely prescribe antibiotics for mild-to-moderate sinus infections unless symptoms last for seven or more days. Most sinusitis is viral and will resolve on its own.
Do these recommendations reset the standard of care? Will they allow physicians to practice medicine less defensively when ordering tests from their diagnostic toolbox?
Rather than limiting choices, the "45 dubious practices" open the door to new discussions with our patients. After all, even with the most challenging of patients, practicing good medicine is still a matter of shared decision-making between doctor and patient.
Ken Teufel, M.D.