Common Medical Practices And Beliefs That Need To Be Abandoned

     It is a sad truth in America that we do not have the best medical care in the world - we only have the most expensive medical care in the world.

     The American board of Internal Medicine has begun a program called “Choosing Wisely” that challenges physicians in different specialties to examine the practices they commonly do and ask: Is this cost-effective? Is this the best medical practice based on science? Is this in the best interest of the patient?

     Each different specialty group has come up with its own list of things that need to change. On March 17^th 2014, the American Academy of Pediatrics came out with their list.  Parents should be aware of it because it includes common things that add to the cost of their children’s medical care without giving any significant benefit.

     The list starts with the statement that antibiotics should only be used when a bacterial infection is the cause of the child’s illness. Most infections that occur in children are viral and don’t need antibiotics, including most cases of sinusitis, sore throat and bronchitis.

     The second is that cough and cold medicines should not be given for respiratory illnesses in children under four years of age. These medications don’t offer young children much relief of symptoms and giving these medications can result in overdoses of some of their ingredients.

     Another is that CT scans of the head are not necessary in the immediate evaluation of minor head injuries. The decision to do a CT scan needs to be based on the results of a good examination, careful observation after the trauma and following specific guidelines for the evaluation of head trauma.

     CT scans, MRIs and head X-rays do not need to be done after a child has had a simple fever seizure (febrile seizure).

     Infants diagnosed as having gastroesophageal reflux because they spit up frequently or are colicky should not get upper GI X-rays and they should not be placed on reflux medication. Reflux is normal in infants and is usually not associated with any more serious symptoms.

     Children should not get general allergy blood tests for a variety of foods just because a food allergy is suspected. Many of these tests are falsely positive - 8% of children have a positive test for peanut allergy but only 1% are truly allergic to peanuts. Specific tests should be done only after a careful history is done.

     There is no evidence that the use of home apnea monitors decreases the incidence of sudden infant death syndrome. They may be helpful in specific circumstances, but they should not be used routinely.

     The most difficult one involves the evaluation of a child’s abdominal pain. It is common practice to do an abdominal CT scan if appendicitis is suspected, however, this is expensive and can expose the child to a large amount of radiation. The new rule is that CT scans are not necessary in the routine evaluation of abdominal pain. Some experts say: if appendicitis is suspected after a careful physical exam is done, an ultrasound should be done (this involves no radiation) and if the ultrasound is questionable, an MRI should be done. Other experts say that the ultrasound is unreliable and the CT scan is the only accurate way to diagnose appendicitis. This controversy will continue for a while.