The second round of listed tests, treatments and procedures that may not be necessary and may cause harm has been released by NPS MedicineWise.   This round has involved 14 colleges, societies and associations, including the RACGP listing their five things clinicians and consumers should question.

Those relevant to General Practice are - 


  • Children with middle ear infections aged between two and twelve should not be routinely prescribed antibiotics treatment. the need to treat needs to be balanced against risk of side effects and evidence that antibiotics do not reduce pain at 24 hours. 
  • Patients with acute uncomplicated bronchitis do not require a chest X ray
  • Do not use percutaneous feeding tubes in patients with advanced dementia, instead use oral assisted feeding
  • Do not provide manual therapy for adhesive capsulitis of the shoulder
  • Do not prescribe topical or systemic antifungal medication for patients with thickened, distorted toenails unless microbiological confirmation of a dermatophyte has been obtained
  • Do not recommend the use of medicines with low dose codeine ( <30mg for adults) for mild to moderate pain
  • Do not conduct thrombophilia screens in adult patients under the age of 50 years unless the first episode of venous thromboembolism occurs in the absence of a major risk factor ( trauma, surgery, immobility) or in the absence of oestrogen provocation or at an unusual site
  • Do not prescribe alpha-1 blockers without first asking the patient about a history of cataract or planned cataract surgery
  • Do not routinely undertake a pelvic examination with a PAP smear
  • Avoid multiple daily glucose self-monitoring in adults with stable type two diabetes on medication that does not cause hypoglycaemia
  • Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is not palpable abnormality of the thyroid gland
  • Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.

The full list of recommendations and discussion points to have with your doctor are available at the website,

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