Quality Prescription For Primary Care Doctors: Do Less

Everybody loves a list. And lists, let’s face, make it easier to set priorities, even for doctors.

So a group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists.

After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more.

So what should family doctors not be doing? The Top 5 list for them goes like this:

1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weks or there are red flags, such as neurological problems. 2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or longer. Or the condition worsens after first getting better. 3. No annual electrocardiograms for low-risk patients without cardiac symptoms. 4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease. 5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.

Some of the advice for internists is the same (No. 1, 3 & 5). But they’re supposed to prescribe only generic statins (simvastatin instead of Crestor) at the start of cholesterol treatment and lay off ordering a battery of lab tests to screen for trouble in otherwise healthy patients.

To help the lists get traction, the doctors who worked on them are going to seek endorsements from consumer and patient safety groups.

The work, organized by the National Physicians Alliance, was funded by a grant from the American Board of Internal Medicine Foundation.