Choosing Wisely: Part 2

I have read that health care costs are rising too fast and that it’s partly due to patients demanding, and doctors doing, too many tests.  Are doctors doing anything to reduce this rise? Part II.

Last time I described three items from the Choosing Wisely campaign, telling us to avoid doing them because the tests/procedures cause more harm than benefit and increase costs unnecessarily.  This week, I’ll conclude with another three.  [You can search on-line for more details under “Choosing Wisely”]  

Item 4:  Don’t use benzodiazepines (such as alprazolam [Xanax] or other sedative-hypnotics (such as zolpidem [Ambien]) in older adults as first choice for insomnia, agitation or delirium.
Studies show that the risk of motor vehicle accidents, falls, hip fractures, and death are double in older adults taking these drugs. Benzodiazepines should be reserved for alcohol withdrawal symptoms or severe anxiety unresponsive to other therapies.

Item 5: Don’t use antibiotics to treat urine bacteria in seniors unless infection symptoms are present.
Studies have found that no problems develop if we don’t treat seniors with bacteria in their urine when they have no symptoms. Treatment only results in increased side-effects from the drugs.  (An exception is if you’re having a procedure involving the urinary tract:  the urine should be examined before ‘surgery’ and if bacteria are present, antibiotics are needed.) 

Item 6:  Don’t leave an Implantable Cardioverter-Defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.
If patients have a defibrillator for their congestive heart failure and have a probable life expectancy of less than six months, and if their goal is comfort, then de-activating the defibrillator will help them avoid possible end-of-life shocks which would not only be quite uncomfortable but could prolong dying and worsen their quality of life.

Thus, the Choosing Wisely campaign by doctors encourages us to do only those tests/procedures that have been shown to be beneficial; or, if they were initially beneficial, stop doing them when the benefit ends.