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First, Do Less?

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Here’s a bit of medical trivia for you. The dictum, “First, do no harm” is not a part of the Hippocratic Oath. It actually comes from Hippocrates’ writing “Epidemics.” (You have to have the correct citation if you’re going to win those exciting Hippocratic bar bets, right?)

Regardless of the source, if the results of a recent survey of 250 members of the National Physicians Alliance (NPA) were taken into account, the statement might be modified to “First, do less.” The group has become concerned about the (sometimes) questionable medical value of new technologies and treatment patterns. With that in mind, NPA asked its members to list five recommendations in each of three practice areas: family medicine, internal medicine and pediatrics.

The results are fascinating, though not terribly surprising – especially in light of reports (New England Journal of Medicine, etc.) over the past few years questioning the value of annual physicals for asymptomatic patients. For example, in the area of pediatrics, the group suggests that physicians not prescribe antibiotics for every sore throat – only those where the patient tests positive for strep throat. Pediatricians should not order diagnostic images for minor head injuries without the loss of consciousness or other risk factors.

Internists should not order imaging studies for lower back pain within the first six weeks unless red flags are present. They are also advised not to obtain blood chemistry panels or urinalysis for asymptomatic healthy adults. Family practice physicians should not routinely prescribe antibiotics for mild to moderate sinusitis, and should avoid ordering annual EKGs or other cardiac screenings for low-risk patients without other symptoms.

Basically, the survey boils down to this: use more common sense and fewer dollars and cents. Who knew?

To read more blogs from David Saltzman, click here.