February 13, 2013

In My Opinion: Doctors support Choosing Wisely


Choosing Wisely is trying to limit unnecessary tests, not medically necessary tests.

2. Choosing Wisely is not Obamacare. Choosing Wisely is written by doctors. It is not run by the government, insurance companies or HMOs. Medical experts are trying to help you and your doctor do what is best for your health — and maybe save some money at the same time. The government is not involved.

Choosing Wisely was written by medical experts in nine specialties, each recommending five tests or treatments that should not be done.

It is important to stress that Choosing Wisely recommends not doing certain tests in specific situations. For example, it recommends that nuclear stress tests not be done for stable heart patients on a regular basis. This does not mean that nuclear stress tests should never be done, but rather that they be done for the right reason.

Here is a list of some of the other 44 recommendations:

▶ Antibiotics should not be used for most colds or sinus infections. Antibiotics usually don’t help and they carry a risk of side effects, sometimes serious ones.

▶ Most people with back pain lasting less than six weeks do not need X-rays. It is rare that a serious and treatable problem will be found.

▶ Most patients without heart disease, or with stable heart disease, do not need stress tests. The results rarely change treatment but can lead to unnecessary tests or invasive procedures.

▶ CT scans of the head are not necessary for most people who pass out (faint) or who have headaches. They rarely reveal the cause of the problem.

▶ Drugs for treatment of acid reflux or GERD should be used at the lowest doses necessary to control symptoms.

▶ Avoid or limit the use of NSAIDs (ibuprofen, Motrin, Advil; or naproxen, Aleve, Naproxen) in patients with high blood pressure, diabetes, heart failure or kidney disease. There is a small risk of causing kidney problems.

▶ The decision to start dialysis in patients with kidney disease and other serious medical problems is not always helpful; a detailed discussion about the risks and benefits is very important.

If you would like to read more about this, check out

Dr. Joel Wolkowicz is medical director of cardiology and president of the medical staff at CVPH Medical Center.

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