As healthcare budgets become increasingly important to become sustainable , Medical colleges, societies and associations are uniting to identify over 50 tests, treatments and procedures that are of proven low value or carry unnecessary risk.  The first wave of recommendations were announced in April 2015 and are available at  The next wave of recommendations will launch on March 16 2016. The recommendations help make decisions and areas requiring discussion when considering a referral for testing.

A list of five tests and treatments that require discussion from the initial publication are:

1. Antibiotics

There has been an increased awareness of the risk of antibiotic resistance and the association with overuse of antibiotics. Most people do not need antibiotics for cold or flu illnesses which are caused by viruses ( not treated by antibiotics) antibiotics can also have side-effects for more information see NPS MedicineWise antibiotic resistance

2. Investigation for fatigue

It is estimated that up to one in five GP visits include fatigue as a symptom. The initial response often is to order multiple tests, these are often repeated over short time intervals. For young adults with no other signs or symptoms of underlying serious illness a physical condition is unlikely to explain the fatigue and lifestyle interventions and waiting may be useful approach. When the odds of a disease are low, the tests have a higher chance of a false positive result creating anxiety and further needless investigation.

3. X-rays and Scans for back pain

Low back pain is common, it is thought 80 per-cent of people will experience back pain during their life. Evidence demonstrates that without further symptoms such as leg pain or numbness, a history of cancer, unexplained weight loss, imaging offers no assistance to treatment and may find abnormalities requiring further unrelated and unhelpful investigation. X-rays and c-t scans also involve radiation and an increase in cancer risk to the person. More detailed information is available at NPS MedicineWise low back pain

4. Vitamin D testing

Those at risk of deficiency who have darker skin, who wear covered clothing with minimal sun exposure, who are pregnant or breast feeding or have osteoporosis or altered gut absorption may require testing. Vitamin D testing is less helpful for healthy adults under 50 years of age without symptoms or risk factors as the effects of mild deficiency is unclear

5. Medicines for acid reflux

High dose proton pump inhibitors ( PPIs) taken for more than 1 year have been linked to an increase risk of bone fractures, lower magnesium blood levels, medication interactions and bowel infection with clostridium difficile. The medication is required for severe and frequent heartburn ( twice a week or more for several weeks), but are recommended to be used at the lowest dose and to trial taking them when the symptoms occur. Further details are available at NPS MedicineWise Medicines for heartburn and reflux

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