Seventeen U.S. medical specialty boards have identified 90 common tests and procedures that they say doctors should perform less frequently.
The recommendations include avoiding imaging tests in the early stages of lower back pain, avoiding antibiotics for mild or moderate sinusitis, and not prescribing cough and cold medicines to children under 4.
The medical specialty boards, which represent more than 350,000 physicians nationwide, each developed lists of five specific tests or procedures that physicians and patients should question.
One of the recommendations, made by the American Geriatrics Society, was to avoid antipsychotics as the first choice in treating symptoms of dementia.
“People with dementia often exhibit aggression, resistance to care and other challenging or disruptive behaviors,” according to the American Geriatrics Society. “In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including stroke and premature death.”
Dr. Bruce Anderson, a St. Helena psychiatrist, agreed that avoiding antipsychotics as a first choice was “good advice.”
Physicians should first look for what’s causing dementia, as some causes are treatable and can be reversed, Anderson said. However, some people who have dementia are at risk of harming themselves or others, and in those cases antipsychotics may be the best option, he said.
Anderson gave the example of one of his elderly patients who was living in a skilled nursing facility and showing signs of dementia. The patient had an unexpected outburst and attacked a nurse.
“What do you do when someone is so troubled, and others are in danger?” he said. “Common sense is needed here.”
Dr. Jason Huffman, an orthopedic surgeon from the Napa Valley Orthopaedic Medical Group, said he agreed with the recommendation to avoid imaging tests for lower back pain within the first six weeks, unless red flags are present.
While the radiation exposure from a single X-ray is “minuscule,” it still increases the risk of developing cancer later in life, Huffman said. Another problem with unnecessary imaging tests is that they can produce false positives, he said; in these cases, a patient may undergo more expensive follow-up procedures only to discover that nothing was wrong.
Huffman said the recommendations made by the medical specialty boards should help educate patients — especially with regard to unnecessary radiation exposure.
“It’s not uncommon to have patients feel like they’re not getting served if you don’t order an MRI,” Huffman said. “This helps them understand why.”