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Posted by Dr. Claire McCarthy March 19, 2014 02:17 PM
In medicine, as in many other fields (and aspects of life), just because you can do something doesn't mean you should.
We have come so far in medicine. We have so many tests and medications, many of them new. As doctors, we want to do everything we can to make sure we are taking the very best care possible of our patients--but sometimes, we end up overdoing it. Sometimes in our attempt to help we do things that aren't really necessary, and might even cause harm.
That's where the Choosing Wisely campaign comes in. Funded by the ABIM Foundation, it is a campaign to get doctors to come together and make recommendations for doctors, patients and families so that they can, well, choose wisely. The American Academy of Pediatrics (AAP) has been part of this effort, and recently came out with an updated list of ten tests and treatments you should question as a parent. Here they are:
1. Antibiotics for upper respiratory infections, like sore throats, sinusitis and most coughs. The majority of these illnesses are caused by viruses; not only do antibiotics not kill viruses, they can have side effects--and overuse leads to resistance (the bacteria get smart, and then the antibiotics don't work when we need them to). Sometimes we do need to use antibiotics, such as in strep throat--but if you are getting a prescription for them, be sure to ask your doctor if it's definitely necessary (if the answer is yes, take it!)
2. Cough and cold medicines for children under the age of 4 years. They don't really help, and they can have dangerous side effects. Go for the chicken soup, humidifier, and honey (for kids over a year) instead.
3. CT scans for minor head injuries. We all want to be sure there's no damage when our kid falls off the swing and bumps his head--but most of the time, a good physical examination and some observation gives the answer just as well as a CT scan, and without the radiation exposure. There are clear guidelines for doctors about what to do--if you end up in an emergency room with your child after a head bump, ask about them.
4. CT or MRI for children with simple febrile seizures. These are very common seizures in children, and unless there is something unusual about the seizure or what happened, we don't need to do tests to look at the brain.
5. CT scans for most stomachaches. There's a bit of a theme here, and an understandable one. If you can look and make sure there's nothing bad inside, why not look? Well, because it exposes children to radiation, that's why. So, bottom line: unless you have a really good reason to think you are going to see something on a CT scan, you shouldn't do one.
6. High-dose steroids for preventing lung disease in premature babies. Lung disease is a common complication of prematurity, and it can be lifelong--but high-dose steroids don't actually help, and can cause problems, including brain and development problems.
7. Screening blood tests for food allergies, unless there is a clear reason. I get this request a lot from families, actually. They hear about food allergies, their child has an unclear symptom (like an occasional stomachache or headache) and they want me to find out if there may be an allergy. The problem is that the blood test results can be positive even if there isn't an allergy. So unless the story really does seem like an allergic reaction (there are various symptoms of food allergy--you and your doctor will decide together after questions and discussion), it's better not to do the test.
8. Medications for reflux in babies who spit up--but are otherwise well and growing. Some babies just spit up. They get better with time. The medicines don't make much of a difference, if any, and can have side effects.
9. Urine cultures when there are no signs of infection. If there isn't fever, burning with urination, urinating more frequently, belly ache or other signs of infection, don't bother looking for one. You can sometimes have bacteria in the urine without it causing infection, and then you end up treating something that isn't a problem with antibiotics--which can cause problems.
10. Home apnea monitors to prevent SIDS. This is something that has come up recently, as companies offer understandably scared parents machines that supposedly let them know when their babies stop breathing. But they don't really prevent SIDS--and not only can they have frightening false alarms, they might get in the way of parents watching over their babies properly (because they think the machine is doing it). Machines like these might be a good idea for babies with certain health problems, although this is uncommon--talk to your doctor if you think your baby might need one.
For more information, check out the press release on the AAP website. And, of course, talk to your doctor.
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