Friday, February 22, 2013


I am certain that because of increasing cost of care, many professional associations in USA, probably with severe push and prompting by the insurance / MCO companies, and consumer associations are publishing annual list, not to forget that some of the test may have risks, so that they may do more harm than good. Maybe we call call this campaign, rationalising cardiac investigations. I am embarrassed to say that sometimes test are performed for reasons other that for the benefit of the patients. In this day and age of the flat world and increase risk of litigation and complaints, doctors must exercise due care in requesting and doing test for the patients. Choosing Wisely is to guide and help us.
The societies involved include the American Society of Echocardiography, Society for Cardiovascular CT, and the Society of Thoracic Surgeons, the American Board of Internal Medicine, and the American Academy of Family Physicians. Some of the recommendations include :-
Don't screen for carotid artery stenosis in asymptomatic adult patients (American Academy of Family Physicians).

  • Do not perform a routine predischarge echocardiogram after cardiac valve-replacement surgery (Society for Thoracic Surgery).
  • Avoid using stress echocardiograms on asymptomatic patients who meet "low-risk" scoring criteria for coronary disease (American Society of Echocardiography).
  • Patients who have no cardiac history and good functional status do not require preoperative stress testing before noncardiac thoracic surgery (American Society of Echocardiography).
  • Don't use coronary artery calcium scoring for patients with known coronary artery disease, including stents and bypass grafts (Society for Cardiovascular Computed Tomography).
  • Don't repeat echocardiograms in stable, asymptomatic patients with a murmur/click, where a previous exam revealed no significant pathology (American Society of Echocardiography).
 If you wish to see the full list, please go to

Doctors, please choose wisely.


Winston said...

Doc, in fact, choosing wisely starts with choosing the right doctor itself, to begin with!
Let me relate.
Some years ago, I had some eye infection.
It started with my left eye.
And the ophthalmologist started giving me a few types of medicine to be used through the day.
Then, after about a month, I was told that my right eye was also infected!!!
In the end I ended up using about four to five types of eye drops each day.
That included antibiotic as well as steroid ones.
This carried on for about another month.
And I had to consult him every few days.
All the time, both my eyes became more and more painful.
I kept calling the specialist about the pain in both my eyes.
And that scum kept telling that I was not using the eyedrops!!!
And he kept insisting that I keep using his medication.
In the end, the pain was unbearable and I had to go to another specialist to find out what's wrong.
It was just as well that I did!!!!!!
If not, I would perhaps ended up blind in both eyes!!!!!
The pain in both eyes was so intense that I couldn't even open them for the doctor to check!!!!
Fortunately, he managed to apply some anaesthetic to my eyes which enabled me to do so.
And he found that both my eyes were badly larcerated!!!!
He told me to lay off all the medications that the previous doctor had given me and prescribed Tears Naturale Free for my eyes.
After using this for some time, my eyes finally became okay again.
The lesson to be learnt from this is: Change your doctor if your condition don't improve after some time!!!!
Also, some doctors are completely unscrupulous, judging from the fact that I did go for frequent follow-ups and the larceration in my eyes were "overlooked"!
Perhaps, he wanted me to prolong my visits as the consultation fees charged were quite high!!!!
Thank you.

hmatter said...

Hi Winston, I am so sorry that you had to suffer longer than necessary. I am glad that you are OK now.
Of course you are right. Choosing the "right" doctor is implied in the posting.
On this subject, I have two points to make
1. It is the duty of the government of the day, that doctors are fully qualified and well trained, before they are allowed to touch patients. It is their responsibility to ensure certification and credentialling. When medical education becomes a business to make money, we are all now at risk.
2. I tell all my patients, if you have an emergency ( life and death situation ) you have to trust whoever is on call then. You do not have much choice. If you are in an elective situation, you should seek second opinions especially when things are not going according to plan.
I am too long winded now.
Yes, some doctors, not all doctors, do "treat for bread", unfortunately. To them, it is a business mah...........