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Panel targets primary care "don'ts"

By — Posted June 3, 2011

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When it comes to providing primary care, physicians should adopt the motto of the German minimalist architect Ludwig Mies van der Rohe: "Less is more."

That is the message of a set of recommendations published online May 23 in Archives of Internal Medicine that advises internists, family physicians and pediatricians on the top five commonly ordered interventions that should be avoided in each of their specialties (link).

A panel of 15 physicians analyzed medical literature to compile top-five "don't" lists of health care activities that are wasteful because they are not supported by evidence. Examples from the three top-five lists include: imaging for low back pain of less than six months when neurological deficits are not present; ordering blood chemistry panels or urinalyses for screening in healthy adults; prescribing antibiotics for sinusitis; and annual electrocardiograms for asymptomatic patients.

Researchers then surveyed 255 primary care physicians about whether they agreed that the interventions targeted on the top-five "don't" lists were commonly ordered, were important to improving quality, would save money, could be avoided easily and proved to be without value by medical evidence. The vast majority of physicians agreed with the recommendations.

"When I originally came up with the idea, I was influenced by David Letterman's top-10 lists," said Stephen R. Smith, MD, MPH, professor emeritus of family medicine at the Warren Alpert Medical School of Brown University in Rhode Island. "This is something that people can wrap their minds around. It doesn't overwhelm people."

Dr. Smith and his colleagues at the National Physicians Alliance, a liberal doctors organization, have received a grant from the American Board of Internal Medicine Foundation to develop educational materials for physicians as well as videos to inform patients about the top five don'ts. The latter is intended to help address concerns that patients often pressure physicians for care that is unsupported by the evidence according to the premise that more care is always better.

"We plan to put out a DVD and have practices show it between cartoons in the waiting room," Dr. Smith said. "The more the patient is informed, the easier it is going to be for a doctor."

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