Monday, April 9, 2012

Choosing Wisely: Evidence-Based Medicine Comes to the Masses

Last week, nine medical specialty societies (in concert with the ABIM Foundation) announced lists of tests and procedures that are frequently used, but show little clinical evidence of effectiveness.  Interestingly, each of the "lists" is titled: Five Things Physicians and Patients Should Question.

That's physicians... and PATIENTS.  I congratulate the Choosing Wisely initiative for involving the patient in the care decision, empowering the patient to participate in the decison-making process, and expecting that the patient can bear this responsibility. 

My personal favorite comes from the American College of Physicians:
Don’t obtain imaging studies in patients with non-specific low back pain.  In patients with back pain that cannot be attributed to a specific disease or spinal abnormality following a history and physical examination (e.g., non-specific low back pain), imaging with plain radiography, computed tomography (CT) scan, or magnetic resonance imaging (MRI) does not improve patient outcomes.

And similarly from the American Academy of Family Physicians:
Don’t do imaging for low back pain within the first six weeks, unless red flags are present.  Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits.

The lists from all nine groups can be found here.

This is excellent work in that it is:
1) Data-driven
2) Consenus-backed
3) Patient-focused

For your reference, the nine participating groups were:
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology

Now if we could only get the American Academy of Pain Management to participate...

On Twitter @PRIUM1

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