WSYDD-What Should Your Doctor Do?-Suggestions For Dialog With Your Primary Care Doctor

According to the National Physicians Alliance, these are five guidelines that your primary care physician should follow:


1. Don’t do imaging for low back pain within the first six weeks.  Although low back pain is the fifth most common reason for all physician visits, X-rays of the lumbar spine before six weeks does not improve outcomes but does increase costs.


2. Don’t obtain blood chemistry panels (glucose, calcium, uric acid) or urinalyses for screening in asymptomatic, healthy adults.  It is recommended to do lipid screening (cholesterol, triglycerides) which yields significant numbers of positive results even among asymptomatic patients.  It is appropriate to screen for diabetes with a glucose test in asymptomatic adults with hypertension

3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.  There is little evidence that detection of heart disease in asymptomatic patients at low risk for coronary heart disease improves health outcomes.  False positive results are common and false-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment, and misdiagnosis

4. Use only generic statins (Mevacor® (lovastatin) Pravachol® (pravastatin),Zocor® (simvastatin) when initiating lipid-lowering drug therapy.  All statins are effective in decreasing mortality, heart attacks, and strokes when dose is titrated to effect appropriate LDL-cholesterol reduction.  It is acceptable to switch to more expensive brand-name statins (atrovastatin [Lipitor] or rosuvastatin [Crestor]) only if generic statins cause clinical reactions or do not achieve LDL-cholesterol goals

5. Don’t use DEXA screening (test for bone mineral density) for osteoporosis in women under age 65 or men under 70 with no risk factors.  This test is not cost effective in younger, low-risk patients, but is cost effective in older patients

Bottom Line: So What Should Your Doctor Do?  He or she should weight the potential harms of routine annual screening to make sure the harms are much less than the potential benefit.  Only with a meaningful dialog should routine testing and screening be performed in asymptomatic young men and women.

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One Response to “WSYDD-What Should Your Doctor Do?-Suggestions For Dialog With Your Primary Care Doctor”

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