Galveston pediatrician Ben Raimer, MD, wants to make patients and physicians think twice about medical practices that are done out of habit or without proper evaluation.
Dr. Raimer, who specializes in behavioral health in children, focuses on making doctors and patients more aware of the Choosing Wisely initiative. He says antibiotic overuse and unnecessary imaging are areas where patients must begin to choose wisely.
"Choosing Wisely not only saves money, but it also leaves the patient in a lot better health," Dr. Raimer said.
The Choosing Wisely campaign promotes healthy dialogue among physicians and their patients. Begun in 2012, this physician-led movement attempts to eliminate unnecessary tests and procedures predicated on evidence-based recommendations. These recommendations come from leading medical specialty societies that have identified the most salient issues patients should discuss with their physicians. TMA is working with the ABIM Foundation and Robert Wood Johnson Foundation to make physicians and the public more aware of the lists and encourage their use.
The American Academy of Pediatrics brought forth 10 Choosing Wisely recommendations for pediatricians, covering topics such as the unnecessary use of antibiotics and the overuse of certain imaging procedures, like x-rays and computed tomography (CT) scans. They include:
• Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, and bronchitis).
• Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children younger than 4 years.
• CT scans are not necessary in the immediate evaluation of minor head injuries. Clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
• Neuroimaging is not necessary in a child with simple febrile seizure.
• CT scans are not necessary in the routine evaluation of abdominal pain.
Dr. Raimer says many patients will have tests done by "reflex" because doctors recommend them. Injured children will undergo expensive imaging procedures such as x-rays and CT scans. He says "there is no scientific reason" patients should have these expensive tests if they are not predicated on symptoms.
"Families are on fixed incomes, and you don't want to waste money on tests or treatments that are not scientifically proven or effective," Dr. Raimer said.
He also says patients have built up a resistance to certain antibiotics like penicillin because of their overuse. "People get a sore throat and think they should get an antibiotic, penicillin shot," he says, adding that patients should have this medication only after a culture or strep throat test has been performed.
"Overall, Choosing Wisely is an absolutely wonderful program," he says.
Dr. Raimer is concentrating on making patients and physicians aware of medical practices done out of habit or without proper evaluation. For more information, visit www.texmed.org/choosingwisely.
Texas Medicine, Nov. 2014