A new campaign hopes to persuade
doctors from carrying out unnecessary –
or even harmful – procedures and tests.
Here are some you should watch for
Medicating young kids. Photograph:
Imgorthand/Getty Images
Health & wellbeing Doctors Health
Parents and parenting Family More…
Alternative medicine Back pain GPs
Ann Robinson
Sunday 28 September 2014 14.00 EDT
A campaign, Choosing Wisely, to help
doctors to cause less harm is gaining
momentum across the world. It began in
the US two years ago, with the American
Board of Internal Medicine (ABIM)
helping specialists to compile lists of
unnecessary or harmful medical
interventions in their field. In the UK, the
National Institute for Health and Care
Excellence (Nice) drew up its own list of
“do not do” guidance for doctors . But old
habits die hard and doctors still routinely
prescribe tests, drugs and procedures
that are useless to you. Here are five do-
not-dos that doctors continue to flout.
1. Do not scan for lower back pain
Lower back pain usually gets better
within a month. People who have x-rays,
CT or MRI scans are more likely to end
up having an operation than those who
don’t have the tests. But, on average,
both groups recover in the same time
period. Around 99% of people with lower
back pain who go to their GP have a
mechanical problem that will usually sort
itself out. But how do you know whether
you’re part of the unlucky 1%, with a
serious underlying condition that needs
urgent attention? Doctors are trained to
identify the danger signs, or red flags,
which should trigger intervention. These
include a previous cancer diagnosis,
osteoporosis, or a recent bad fall. You
can find the red flags on the NHS Choices
website .
Bottom line: Don’t have a scan or x-ray
for mechanical lower-back pain in the
first six weeks.
2. Do not prescribe cough medicines to kids
Most coughs and colds in kids are caused
by viruses – symptoms typically last for a
few days, then get better. Paracetamol or
ibuprofen are OK to give for a high fever.
Antibiotics don’t work against viruses –
and remedies for tickly or dry coughs,
runny or blocked noses and sore throats
shouldn’t be prescribed either, says the
American Association of Pediatrics (AAP)
in its contribution to the Choosing Wisely
campaign. “Many coughs and cold
products for children have more than
one ingredient, increasing the chance of
accidental overdose if combined with
another product.”
Bottom line: Wipe their noses by all
means, but go easy on the cough syrup.
3. Do not do random allergy tests
A huge variety of symptoms are
attributed to “food allergies”, though
people are often unsure what they might
be allergic to. But attributing symptoms
like bloating, abdominal pains and
weight loss to “allergy” can be
misleading, and could mean a serious
underlying condition is missed. If you
suffer an allergic reaction, the key is to
identify the culprit by recalling what
you’ve eaten. Usually, there’s little doubt.
If you vomit, swell up or nearly stop
breathing when you eat poppy seeds, you
don’t need a test to tell you you’re
allergic. And if a blood test tells you that
you’re allergic to peanuts but you can eat
them with impunity, then you don’t need
to avoid them. In fact, 8% of the
population test positive to peanuts on
allergy testing, but only 1% are truly
allergic and get symptoms when they eat
them.
Bottom line: Allergy tests are for people
who have “proper” allergic reactions.
4. Do not medicate “happy spitters”
Babies are messy creatures. They spit up
their milk, burp and cry. Some are
diagnosed as having gastroesophageal
reflux or GER. But if they are gaining
weight and breathing OK, there is no
need to medicalise or medicate them.
“Parents should be counselled that GER
is normal in infants and not associated
with anything but stained clothes” says
the AAP. Further investigation is only
warranted if the baby is not thriving or
has respiratory problems. Drugs that
block acid (such as ranitidine ) and act on
the gut (such as metoclopramide ) are
commonly prescribed by paediatricians,
especially in the private sector. But the
experts says infant GER rarely causes any
long term harm and that these drugs
don’t help either in the short or long
term.
Bottom line: Possetting (regurgitating
milk) is normal for babies.
5. Do not advise taking St John’s wort for
depression
According to Nice , there is evidence that
St John’s wort (SJW) may help mild or
moderate depression. Nevertheless,
doctors should not prescribe it or even
advise its use, because it is hard to be
certain of the correct dose, there’s no
standardised preparation and its effects
can last variable lengths of time. SJW
also interacts with lots of other drugs,
including the contraceptive pill and
blood-thinning drugs, such as warfarin.
Bottom line: Just because it works,
doesn’t mean you should take it.
The problem with all these is that old
habits die hard: doctors can go on a
course to learn about new evidence, but
it’s harder to change actual practice. For
instance, Choosing Wisely says patients
and doctors should question giving
antibiotics to kids with ear infections if
they’re not seriously unwell – the
potential harm outweighs the benefits.
But faced with a screaming kid and
sleep-deprived parent, many GPs
routinely prescribe antibiotics.
The campaign also says that there’s no
need for a vaginal examination before
starting the contraceptive pill. Routine
but intrusive examinations are taught in
medical schools but often have no real
rationale. And several screening
programmes also need to be challenged
as they cause unecessary anxiety, and
don’t really help. For instance, routine
screening for prostate cancer by blood
test or a digital rectal examination is of
questionable value and men should only
opt for screening if they’ve been fully
informed about the pros and cons. So
before tolerating a a needle in your arm
or taking a prescription to the chemist,
have a proper chat. It might just be one
of those “do not dos”.
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