Medical procedures including automatically prescribing antibiotics for children with middle ear infections offer little benefit, are a waste of time and money and risk causing unnecessary anxiety or even harm, a group of heath organisations has said.
Thirteen peak health and medical bodies on Wednesday jointly released a list of 61 tests doctors are being urged to reconsider, including chest x-rays in patients with uncomplicated acute bronchitis and a pelvic examination during a pap smear.
The Australian College for Emergency Medicine, the Australian and New Zealand Society of Palliative Medicine, the Royal Australasian College of Surgeons and the Endocrine Society of Australia were among the organisations to contribute procedures to the Choosing Wisely Australia list, which was compiled by NPS MedicineWise.
“During a routine cervical smear for screening, a physical pelvic examination has no proven benefit, as it has not been shown to improve the detection of ovarian cancer,” says one of the recommendations, from the Royal Australian College of General Practitioners.
“The procedure causes pain, fear, anxiety and/or embarrassment in a third of women and can lead to unnecessary, invasive and potentially harmful diagnostic procedures.”
The college also said reviewing middle-ear infections in children aged two to 12 years after 24 and 48 hours was a reasonable option rather than automatically prescribing antibiotics.
“Antibiotics do not reduce pain at 24 hours,” the recommendation states. “One in 14 children will develop antibiotic side effects, particularly rash, diarrhoea or vomiting. Antibiotic use promotes bacterial resistance, both in the individual and community.” But the college emphasised that guidelines differed for Aboriginal and Torres Strait Islander children.
The Australian Physiotherapy Association said imaging should not be requested for patients with non-specific lower back pain, while the Australian and New Zealand Society of Palliative Medicine and Australasian Chapter of Palliative Medicine said feeding tubes should not be inserted into the stomachs of patients with advanced dementia.
“Artificial nutrition does not prolong life or improve quality of life in patients with advanced dementia,” the statement said. “Tube feeding does not ensure the patient’s comfort or reduce suffering; it may cause fluid overload, diarrhoea, abdominal pain and less human interaction.”
The chief executive of the Consumers Health Forum, Leanne Wells, said the list of unwarranted procedures was sorely needed. Patients should not be afraid to question doctors about the evidence for procedures being ordered and to ask about any risks and benefits, she added.
“We want to put consumers back in control of their healthcare and their lives,” Wells told Guardian Australia.
“To do that we need to improve the health literacy of the community. Giving people the information in these list empowers them to take control and to know it’s OK to ask their doctor what they are suggesting something and that it is OK to refuse treatment and tests.”
There was a growing body of evidence that people were undergoing unnecessary procedures and tests, Wells said, a core reason why expenditure on health was growing so rapidly.
“It is also a cost to the community in wasting valuable health resources, clinicians’ time, hospital beds, expensive equipment on interventions that have no real benefit and can do some harm.
“Whilst people argue about the extent of the wastage there is no one saying there is not waste. If we want to ensure Medicare is sustainable then we need to reduce wastage and only do interventions that are necessary.”
Dr Ken Harvey, an adjunct associate professor with Monash University’s school of public health and preventive medicine, said about a third of money spent on healthcare was “probably unnecessary, wasteful and sometimes harmful”.
“This is especially true for medical interventions near the end of life,” Harvey said.
“Ironically, many doctors die differently from their patients. They don’t want fancy treatment, expensive chemotherapy offering little benefit or cardiopulmonary resuscitation. They know the downsides and they just say no.”