News

18-05-2015

The program follows from an American initiative that started in 2009 and has steadily increased in the number of medical societies involved and broadened to include a number of other countries also adopting the process. Physicians identified tests , treatments and therapies their field over-used and encouraged patients to hold a conversation about these practices with their doctor , to reduce unnecessary tests and investigations and associated healthcare costs. Each recommendation created is supported by clinical guidelines, evidence or expert opinion.

To date, six Australian Medical Colleges have each recommended five services or tests that doctors and patients should question before undertaking. Pathology, imaging and other tests are vital in the diagnosis and screening of disease, however over-testing has emerged as a significant issue for patients, doctors and the health system. Australian data suggests that pathology testing does not always follow recommended guidelines , with 25-75% of tests not supported by evidence or expert opinion. The challenge is to identify what is helpful and what is not.
Inappropriate testing increases healthcare costs and unexpected abnormal results can result in a cascade of further testing and a greater risk of complications ( eg radiation from CT scanning) , anxiety and individual costs.
The lists are designed to promote a conversation about the need or lack there-of for many frequently ordered treatments and tests ( eg X-rays for low back pain , some antibiotic use and preoperative bloods tests)
The Royal Australian College of General Practice has drawn up the five tests GPs should think carefully about and discuss with patients before ordering . GPs across Australia are divided about the campaign, the clinical rationale for listing the five activities is not being questioned, but there is concern about the legal consequences following the inevitable exceptions , for example the person with a spinal tumor with a rare presentation . Others are supportive of the campaign, GPs are often in a position where a patient is not satisfied until a test or prescription is done. The specialty society lists provided can help with the difficult conversation regarding the need for the tests or procedure. The College is recommending that Choosing Wisely lists are seen as a basis for discussion rather that a set list of rules. The objective of Choosing Wisely is for improved safety and quality through reducing practices of little clinical benefit.

The five general practice recommendations are:

See: 
choosingwisely.org.au

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