American medicine, often touted as the finest in the world, is not! In 2000, the World Health Organization rated the United States health care system as 37th in the world. We rank in the lowest quartile of developed countries in infant mortality and life expectancy. At the same time, we spend 2-1/2 times more on medical care per person than many western European countries that deliver superior care.

Recently, many of the medical specialties in the U.S. have identified procedures and practices whose implementation or elimination could lead to significant health benefits and reduce risks, harms and costs. The initiative is called “Choosing Wisely.”

Here are some of the Choosing Wisely recommendations from the American Academy of Family Physicians.

---

---

• DO NOT expose yourself to X-rays or an MRI for low back pain within the first six weeks of symptoms unless there are red flag warnings that something bad is going on. A very high percentage of low back pain episodes resolves within three weeks.

• DO NOT do DEXA screening for osteoporosis if you are a woman younger than 65 or a male less than 70, if you have no risk factors (smoking, previous fracture, positive family history).

---

---

• DO NOT get a pap smear if you are a woman under 21 or have had a hysterectomy for non-cancer disease. Most pap smear abnormalities in adolescents regress spontaneously.

• DO NOT go to your doc or the traveling ultra-sound clinics that frequent our town for a carotid (neck) artery evaluation. There is good evidence that for adult patients with no symptoms of carotid artery blockage, that the harms outweigh the benefits. Screening can lead to non-indicated surgeries.

Finally, DO NOT seek antibiotics for acute mild-moderate sinusitis unless your symptoms last for seven or more days, or symptoms worsen after initial improvement. Most sinus infections are caused by viruses and will get well on their own.

Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans.