Top 5 List in Family Medicine

1. Don’t do imaging for low back pain within the first six weeks, unless the patient has red flags like progressive neurological deficits. Low back pain is the fifth most common reason for all physician visits, but early imaging only increases costs without improving patient outcomes.
2. Don’t routinely prescribe antibiotics for mild or moderate sinusitis, unless symptoms last more than seven days or worsen after an initial improvement. Despite the fact that most sinusitis is caused by a viral infection, antibiotics are still prescribed in more than 80% of outpatient cases. That adds up: each year sinusitis results in 16 million office visits and $5.8 billion in costs, even though viral infections will clear on their own.
3. Don’t order annual ECGs or other cardiac screening for healthy, low-risk patients with no symptoms. False-positives and other potential harms of the tests, such as unnecessary invasive procedures and overtreatment, are likely to exceed the benefits.
4. Don’t perform Pap tests on patients under 21 or in women who have had hysterectomies for benign disease. In these populations, Pap smears tend to cause unnecessary anxiety and cost, with no improvement in patient outcomes.
5. Don’t do DEXA bone scans to screen for osteoporosis in women under 65 or men under 70 with no risk factors. The scans aren’t cost-effective in younger patients, unless they have risk factors like calcium or vitamin D deficiency, fractures after age 50, long-term corticosteroid use, smoking or alcoholism.