Choosing Wisely – RACGP
Low-Value Care Recommendations – Clinical Takeaways (General Practice / CCE)
| Recommendation (“Don’t…”) | Why It’s Low-Value | Practical Takeaway for Daily Practice / CCE |
|---|---|---|
| Use PPIs long-term in uncomplicated disease without step-down | Long-term PPI use → ↑ fracture CKD C. difficile micronutrient deficiency symptom benefit plateaus after 4–8 weeks | At chronic disease reviews: • Confirm indication • Trial step-down: half-dose / on-demand / cease • Document counselling + red flag advice |
| Start antihypertensive or lipid therapy without 5-year absolute CVD risk | Single-risk factor use → over/under-treatment; absolute risk better predicts benefit | Use NVDPA calculator in consult; • Repeat every 2 years or if risk changes • Mention absolute risk in OSCE cases |
| Recommend routine SMBG in T2DM on oral meds only Self-monitoring blood glucose (SMBG) | ≤0.3% HbA1c reduction ↑ cost, anxiety; no long-term outcome benefit | Focus on HbA1c every 3 months SMBG if: • Driving • Steroid use • Medication changes • Hypoglycaemia risk |
| Screen asymptomatic adults (<5% 5-year CVD risk) with – ECG – stress test – CAC – carotid US | Low PPV → false positives, over-investigation, anxiety | Reassure and document shared decision if requested Emphasise lifestyle and modifiable risk control |
| Prescribe benzodiazepines in pts with – (Substance Use Disorder) or – polypharmacy | High risk of dependence, overdose, ED use (synergistic effects) | Prefer CBT-I, mindfulness, melatonin or sedating antihistamines If used: • Limited supply • Monitoring • SafeScript |
| Order colonoscopy for screening in average/slightly above-average risk | Biennial iFOBT halves mortality; colonoscopy has risks (e.g., perforation ≈1/1000) | Enrol eligible patients (45–74 yrs) in NBCSP Colonoscopy only if: • Positive iFOBT • High-risk family history |
| Order chest X-ray in uncomplicated – acute bronchitis | >90% viral; CXR rarely changes management | Use vitals + CRB-65 to exclude pneumonia Provide safety-netting and education on viral illness course |
| Perform bimanual pelvic exam with – routine cervical screening | No benefit in asymptomatic women; ↑ anxiety, false positives | Use self-collection or speculum-only unless symptoms present Bimanual reserved for: pain, abnormal bleeding, mass |
| Treat uncomplicated AOM with antibiotics in – non-Indigenous children (2–12y) if review possible | 80% resolve spontaneously; antibiotics = small pain benefit but ↑ side effects and resistance | Give analgesia + safety-net Rx Review in 48h if no improvement or systemic features |
| Screen asymptomatic adults with TFTs | Low yield; high false positives → overtreatment | Only check TFTs if: • Symptoms of thyroid disease • Goitre • Atrial fibrillation • Dyslipidaemia • Pregnancy planning • On lithium/amiodarone |
