Choosing Wisely: Part 3

Two months ago I discussed the Choosing Wisely campaign by doctors to reduce unnecessary tests or procedures.  Below are several more, this time from the AAFP.
The American Academy of Family Physicians has now added their recommendations to those from other  medical societies regarding things that doctors and their patients should question (because the test or procedure doesn’t help patients improve). 
Don’t routinely prescribe antibiotics for acute sinusitis unless symptoms last more than seven days or symptoms worsen after initially improving.  Significant symptoms include colored nasal drainage, tender sinuses.  Most sinus infections are viral and no antibiotic will help:  the drugs will only increase the risk of the bacteria being more resistant.
Don’t do back x-rays for low back pain within the first six weeks, unless some specific findings are present (such as progressive weakness/numbness, fevers, loss of bladder control).
• Don’t screen for osteoporosis with bone scans in women under 65 or men under 70 unless they have risk factors (such as fractures, family history, smoking).
• Don’t do routine annual EKG’s for low-risk patients without symptoms.  There’s no evidence it helps improve outcomes.
• Don’t do Pap smears on women under 21 or those who have had a hysterectomy for non-cancer disease.  
• Don’t screen for carotid artery stenosis [hardening/narrowing of neck arteries] in adults without symptoms (such as a mini-stroke).  Screening may lead to “false-positives”, meaning a narrowing may be found which would never cause a stroke but which might trigger an unnecessary surgery which itself could lead to stroke or even death.
• Don’t screen women over 65 for cancer of the cervix if they’ve had normal pap smears and are not at high risk for cervical cancer.
• Don’t routinely screen for prostate cancer using a PSA [prostate-specific antigen] blood test or rectal exam.   PSA-based screening leads to over diagnosis of tumors, most of which will not harm patients, while the risks of treatment are significant.  Patients need to understand the risks and benefits of PSA tests and make an informed, shared decision with their doctor before choosing to have it.
Physicians are making the point that many ‘routine’ tests will not help you to live longer or more comfortably, but only increase the costs of health care; and that patients are encouraged to question the benefit of any test or procedure.