Royal College of Pathologists of Australasia leads off in campaign to list poor medical practices

Australia's medical community to unite in 2015 for a new initiative - Choosing Wisely Australia®

A new initiative facilitated by NPS MedicineWise will see several Australian medical colleges put together lists of ‘top 10’ unnecessary practices in their field in a bid to curb excessive tests, procedures and prescribing. NPS MedicineWise is an independent, not-for-profit organisation funded by the Commonwealth Government. It provides practical tools and information with the aim to improve the way health technologies, medicines and medical tests are prescribed and used in Australia.

The Choosing Wisely Australia® initiative is based on a US program, launched in 2012, with similar goals. The Royal College of Pathologists of Australasia (RCPA) has released their list of the top ten test requests that are most often used inappropriately. RCPA President, Associate Professor Peter Stewart said the new guidelines aimed to reduce inappropriate ordering by clarifying the often confusing information around pathology testing.

Best practice in pathology: the RCPA's top 10 test tips

  • Do not perform surveillance urine cultures or treat asymptomatic bacteriuria in older patients unless there are urinary tract signs and symptoms.
  • Do not perform population-based screening for vitamin D deficiency.
  • Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 10 years.
  • Do not perform routine pre-operative screening tests for low-risk surgery.
  • Do not perform IgG4 allergy tests, total IgE (or indiscriminate batteries of IgE tests) in the investigation of allergy.
  • Do not perform heavy metal tests for non-specific symptoms in the absence of exposure.
  • Do not test for Lyme disease for non-specific symptoms in the absence of exposure (travel to endemic areas).
  • Do not perform serum tumour marker tests except for the monitoring of a cancer known to produce these markers.
  • Do not routinely test and treat hyperlipidaemia in those with a limited life expectancy.
  • Do perform high sensitivity D-dimer assay in outpatients rather than imaging to exclude venous thrombo-embolism in patients with a low clinical probability.


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