Waste. It’s everywhere.

As frontline doctors, we have the responsibility to focus our efforts on high-value healthcare, and reject the interventions with negligible benefit.

But how can you, the Junior Medical Officer, contribute to the rational use of our precious healthcare resources?

After all, you’re not the orthopaedic surgeon performing knee arthroscopies for osteoarthrits, or the gynaecologist ablating the uterine nerve for chronic pelvic pain.

Fear not, Choosing Wisely Australia is here to help. These benevolent folks have called on the professional colleges to name and shame their low-value practices.

Here are 5 of the Choosing Wisely recommendations that have been beneficial to my clinical practice as a JMO:

  1. Think twice before requesting coags

“Avoid coagulation studies in emergency department patients unless there is a clear defined specific clinical indication, such as monitoring of anticoagulants, in patients with suspected liver disease, coagulopathy, or in the assessment of snakebite envenomation.” – Australasian College for Emergency Medicine

It’s so easy to scribble ‘coags’ on the pathology form. Unless it will help you, just don’t.

  1. PERC and Well’s to rule out pulmonary embolism

“Don’t request any diagnostic testing for suspected pulmonary embolism (PE) unless indicated by Wells Score (or Charlotte Rule) followed by PE Rule-out Criteria (in patients not pregnant). Low risk patients in whom diagnostic testing is indicated should have PE excluded by a negative D dimer, not imaging.” – The Royal Australian and New Zealand College of Radiologists

The Well’s score is your friend. It’s as easy as punching it into the MedCalc app that I suggest you download to your phone.

Ruling out PE clinically saves: playing the D-dimer lottery, an 18-guage cannula for your patient, a load of nephrotoxic contrast, and an encounter with a jaded radiology registrar.

  1. It’s viral!

“Avoid prescribing antibiotics for upper respiratory tract infection.” – Australasian Society for Infectious Diseases

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  1. Ottawa Ankle Rules

“Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules.” – Australian Physiotherapy Association

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  1. Imaging low back pain

“Don’t perform imaging for patient with non-specific acute low back pain and no indicators of a serious cause for low back pain.” – The Royal Australian and New Zealand College of Radiologists

Low back pain is ubiquitous in ED. Know you red flags, perform a thorough lower limb neurological exam and do your best to avoid imaging. And I don’t know about you, but lumbar spine X-rays are a pain to interpret.

More is not always better. Overinvestigation, overdiagnosis and overtreatment are a real burden. And remember, this is not all about the bottom line – low value practice can lead to real harm. Think the person that has a side effect to those ‘just in case’ antibiotics, or the anxious wait for the result of a colonoscopy that had no clear indication to begin with.

As the next generation of practitioners, we can make change.

We can choose wisely.

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