The Council of Medical Colleges (CMC) previously facilitated the Choosing Wisely campaign in New Zealand, as part of its commitment to improving the quality of care for all consumers.
This information is not being actively updated. For information on the history of the campaign please contact enquiries@cmc.org.nz
Unnecessary tests do not add value to you or your whānau
Just because tests and treatments are available, doesn’t mean we should always use them.
Tests, treatments and procedures have side-effects and some may even cause harm. For example, CT scans and x-rays expose you to radiation; overuse of antibiotics leads to them becoming less effective; a false positive test may lead to painful and stressful further investigation.
In this section you will find lists and questions relating to specific problems and concerns – and the questions to ask before agreeing to a medical intervention or test.
As each situation is unique, health care professionals and patients should have a conversation to work out an appropriate health care plan together.
Four questions for patients to ask
Some tests, treatments and procedures provide little benefit. And in some cases, they may even cause harm. These questions can help you make sure you end up with the right amount of care — not too much and not too little. As each situation is unique, a discussion with your health professional can help you develop a healthcare plan for you.
1. Do I really need this test or procedure?
Tests may help you and your doctor or other healthcare professionals determine the problem. Procedures may help to treat it. Understanding why your doctor is considering a test -and weighing up the benefits and risks – is always advisable, and is every patient’s right and responsibility.
2. What are the risks?
If you have – or don’t have – the test or procedure, what is likely to happen? Are there potential side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
3. Are there simpler, safer options?
Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more. Or an alternative test or treatment that might deliver useful information, while reducing any potential negative impacts for you.
4. What happens if I don't do anything?
Ask if your condition might get worse – or better – if you don’t have the test or procedure right away.
Patient & consumer resources
Allergies
Don’t use antihistamines to treat anaphylaxis — prompt administration of adrenaline is the only treatment for anaphylaxis.
Anaphylaxis is a potentially life threatening, severe allergic reaction and should always be treated as a medical emergency.
Read more at allergy.org.au
Read more at: https://allergy.org.au/hp/papers/infant-feeding-and-allergy-prevention-clinical-update
Don’t delay introduction of solids to infants – start around 4-6 months.
Read more at: http://allergy.org.au/patients/allergy-prevention/allergy-prevention-frequently-asked-questions/
Read more at: http://allergy.org.au/patients/allergy-prevention/allergy-prevention-frequently-asked-questions
Allergic reaction - severe
Don’t use antihistamines to treat anaphylaxis — prompt administration of adrenaline is the only treatment for anaphylaxis.
Anaphylaxis is a potentially life threatening, severe allergic reaction and should always be treated as a medical emergency.
Read more at allergy.org.au
Infant feeding and allergy prevention
Read more at: https://allergy.org.au/hp/papers/infant-feeding-and-allergy-prevention-clinical-update
Introducing solids to infants
Don’t delay introduction of solids to infants – start around 4-6 months.
Read more at: http://allergy.org.au/patients/allergy-prevention/allergy-prevention-frequently-asked-questions/
Allergy prevention for children FAQ
Read more at: http://allergy.org.au/patients/allergy-prevention/allergy-prevention-frequently-asked-questions
Alzheimer's disease
Antipsychotic drugs are usually not the best choice
People with Alzheimer’s disease and other forms of dementia can become restless, aggressive, or disruptive. They may believe things that are not true. They may see or hear things that are not there. These symptoms can cause even more distress than the loss of memory.
Doctors often prescribe powerful antipsychotic drugs to treat these behaviours:
- Olanzapine (Zyprexa and generic)
- Quetiapine (Seroquel and generic)
- Risperidone (Risperdal and generic)
If you are uncertain if your loved one is taking one of these medications please ask their health care team. In most cases, antipsychotics should not be the first choice for treatment. Here’s why:
Antipsychotic drugs don’t help much. Studies have compared these drugs to sugar pills or placebos. These studies showed that antipsychotics usually don’t reduce disruptive behaviour in older dementia patients.
Antipsychotic drugs can cause serious side effects. Doctors can prescribe these drugs for dementia for behavioural symptoms, but they cause serious side effects.
Side effects include:
- Drowsiness and confusion—which can reduce social contact and mental skills, and increase falls
- Weight gain
- Diabetes
- Shaking or tremors (which can be permanent)
- Pneumonia
- Sudden death.
Other approaches often work better. It is almost always best to try other approaches first, such as the suggestions listed below.
- Make sure the patient has a thorough exam and medicine review.
- The cause of the behaviour may be a common condition, such as constipation, infection, vision or hearing problems, sleep problems, or pain.
- Many drugs and drug combinations can cause confusion and agitation in older people.
Talk to an aged care health professional
This person can help you find non-drug ways to deal with the problem. For example, when someone is startled, they may become agitated. It may help to warn the person before you touch them. For more tips, see below.
Consider other drugs first
Talk to your doctor about the following drugs that have been approved for treatment of disruptive behaviours:
- Drugs that slow mental decline in dementia.
- Antidepressants for people who have a history of depression or who are depressed as well as anxious.
Consider antipsychotic drugs if:
- Other steps have failed.
- Patients are severely distressed.
- Patients could hurt themselves or others.
Start the drug at the lowest possible dose. Caregivers and health professionals should watch the patient carefully to make sure that symptoms improve and that there are no serious side effects. The drugs should be stopped if they are not helping or are no longer needed.
Tips to help with disruptive behaviours
Keep a daily routine. People with dementia often become restless or irritable around dinner time.
- Do activities that use more energy earlier in the day, such as bathing.
- Eat the biggest meal at midday.
- Set a quiet mood in the evening, with lower lights, less noise, and soothing music.
Help the person exercise every day. Physical activity helps use nervous energy. It improves mood and sleep.
Don’t argue with a person who’s distressed.
- Distract the person with music, singing, or dancing.
- Ask the person to help with a simple task, such as setting the table or folding clothes.
- Take the person to another room or for a short walk.
Plan simple activities and social time. Boredom and loneliness can increase anxiety. Adult daycare programmes can provide activities for older people. They also give caregivers a break.
It’s OK to ask questions. If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Download this resource
Adapted from Choosing Wisely Canada (2014), Treating disruptive behaviour in people with dementia. Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
Most people in the last stage of Alzheimer’s disease have difficulty eating and drinking. At this time, families/whānau may wonder if a patient needs a feeding tube. Families/whānau want to do everything possible for someone who is ill. But they often get little information about feeding tubes. And they may feel pressure from doctors or nursing home staff, because feeding is simpler with a feeding tube. But feeding tubes sometimes do more harm than good. Here’s why:
Feeding tubes usually aren’t helpful for severe Alzheimer’s disease
People with severe Alzheimer’s disease can no longer communicate or do basic things. Chewing and swallowing is often hard. This can cause serious problems, such as weight loss, weakness, and pressure sores. Or food can get into the lungs, and cause pneumonia. So people often need help to eat.
In many cases, a decision is made to use a feeding tube. The tube may be put down the throat. Or it may be put through a small cut in the abdominal wall, into the stomach. The patient is then given liquid nutrition through the tube. But tube feeding is not better than careful hand feeding—and it may be worse. It does not help people live longer, gain more weight, become stronger, or regain skills. And it may increase the risk of pneumonia and pressure sores. Hand feeding gives human contact and the pleasure of tasting favourite foods.
When death is near and patients can no longer be fed by hand, families/whānau often worry that the patient will “starve to death.” In fact, refusing food and water is a natural, non-painful part of the dying process. There is no good evidence that tube feeding helps these patients live longer.
Feeding tubes can have risks
- Tube feeding has many risks.
- It can cause bleeding, infection, skin irritation, or leaking around the tube.
- It can cause nausea, vomiting, and diarrhoea.
- The tube can get blocked or fall out, and must be replaced in a hospital.
- Many people with Alzheimer’s disease are bothered by the tube and try to pull it out. To prevent that, they are often tied down or given drugs.
- Tube-fed patients are more likely to get pressure sores.
- Tube-fed patients are more likely to spit up food, which may lead to pneumonia, a term called “aspiration pneumonia”.
- At the end of life, fluids can fill the patient’s lungs, and cause breathing problems.
So when are feeding tubes a good idea?
Feeding tubes can be helpful when the main cause of the eating problem is likely to get better. For example, they can help people who are recovering from a stroke, brain injury, or surgery. The tubes also make sense for people who have problems swallowing and are not in the last stage of an illness that can’t be cured. For example, they can help people with Parkinson’s disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Caring for a person with severe Alzheimer's disease
When caring for a person with severe Alzheimer’s disease, these steps can help with eating problems and other end-of-life concerns:
- Treat conditions that cause appetite loss, such as constipation, depression, or infection.
- Feed by hand. Ask a health professional about the best kinds of foods to offer and the best ways to feed by hand.
- Stop unneeded medicines. Some drugs can make eating problems worse, including:
- antipsychotics such as quetiapine (Seroquel and generic)
- sleeping pills or anti-anxiety drugs such as lorazepam or zopiclone
- bladder-control drugs such as oxybutynin
- some drugs for osteoporosis such as alendronate (Fosamax and generic)
- drugs for Alzheimer’s disease such as donepezil (Aricept and generic).
Schedule dental care. Badly fitting dentures, sore gums, and toothaches can make eating hard or painful.
Plan ahead. Every adult should have an advance directive. It lets you say what kind of care you want and who can make decisions for you if you cannot speak for yourself.
It’s OK to ask questions. If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Download this resource
© 2013 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057).Adapted from Consumer Reports (2013) and Choosing Wisely Canada (2014), Feeding tubes for people with Alzheimer’s disease, developed in cooperation with the Canadian Geriatrics Society.
Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
Alzheimer's disease and other forms of dementia - disruptive behaviour
Antipsychotic drugs are usually not the best choice
People with Alzheimer’s disease and other forms of dementia can become restless, aggressive, or disruptive. They may believe things that are not true. They may see or hear things that are not there. These symptoms can cause even more distress than the loss of memory.
Doctors often prescribe powerful antipsychotic drugs to treat these behaviours:
- Olanzapine (Zyprexa and generic)
- Quetiapine (Seroquel and generic)
- Risperidone (Risperdal and generic)
If you are uncertain if your loved one is taking one of these medications please ask their health care team. In most cases, antipsychotics should not be the first choice for treatment. Here’s why:
Antipsychotic drugs don’t help much. Studies have compared these drugs to sugar pills or placebos. These studies showed that antipsychotics usually don’t reduce disruptive behaviour in older dementia patients.
Antipsychotic drugs can cause serious side effects. Doctors can prescribe these drugs for dementia for behavioural symptoms, but they cause serious side effects.
Side effects include:
- Drowsiness and confusion—which can reduce social contact and mental skills, and increase falls
- Weight gain
- Diabetes
- Shaking or tremors (which can be permanent)
- Pneumonia
- Sudden death.
Other approaches often work better. It is almost always best to try other approaches first, such as the suggestions listed below.
- Make sure the patient has a thorough exam and medicine review.
- The cause of the behaviour may be a common condition, such as constipation, infection, vision or hearing problems, sleep problems, or pain.
- Many drugs and drug combinations can cause confusion and agitation in older people.
Talk to an aged care health professional
This person can help you find non-drug ways to deal with the problem. For example, when someone is startled, they may become agitated. It may help to warn the person before you touch them. For more tips, see below.
Consider other drugs first
Talk to your doctor about the following drugs that have been approved for treatment of disruptive behaviours:
- Drugs that slow mental decline in dementia.
- Antidepressants for people who have a history of depression or who are depressed as well as anxious.
Consider antipsychotic drugs if:
- Other steps have failed.
- Patients are severely distressed.
- Patients could hurt themselves or others.
Start the drug at the lowest possible dose. Caregivers and health professionals should watch the patient carefully to make sure that symptoms improve and that there are no serious side effects. The drugs should be stopped if they are not helping or are no longer needed.
Tips to help with disruptive behaviours
Keep a daily routine. People with dementia often become restless or irritable around dinner time.
- Do activities that use more energy earlier in the day, such as bathing.
- Eat the biggest meal at midday.
- Set a quiet mood in the evening, with lower lights, less noise, and soothing music.
Help the person exercise every day. Physical activity helps use nervous energy. It improves mood and sleep.
Don’t argue with a person who’s distressed.
- Distract the person with music, singing, or dancing.
- Ask the person to help with a simple task, such as setting the table or folding clothes.
- Take the person to another room or for a short walk.
Plan simple activities and social time. Boredom and loneliness can increase anxiety. Adult daycare programmes can provide activities for older people. They also give caregivers a break.
It’s OK to ask questions. If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Download this resource
Adapted from Choosing Wisely Canada (2014), Treating disruptive behaviour in people with dementia. Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
Alzheimer’s disease – feeding tubes – when you need them and when you don’t
Most people in the last stage of Alzheimer’s disease have difficulty eating and drinking. At this time, families/whānau may wonder if a patient needs a feeding tube. Families/whānau want to do everything possible for someone who is ill. But they often get little information about feeding tubes. And they may feel pressure from doctors or nursing home staff, because feeding is simpler with a feeding tube. But feeding tubes sometimes do more harm than good. Here’s why:
Feeding tubes usually aren’t helpful for severe Alzheimer’s disease
People with severe Alzheimer’s disease can no longer communicate or do basic things. Chewing and swallowing is often hard. This can cause serious problems, such as weight loss, weakness, and pressure sores. Or food can get into the lungs, and cause pneumonia. So people often need help to eat.
In many cases, a decision is made to use a feeding tube. The tube may be put down the throat. Or it may be put through a small cut in the abdominal wall, into the stomach. The patient is then given liquid nutrition through the tube. But tube feeding is not better than careful hand feeding—and it may be worse. It does not help people live longer, gain more weight, become stronger, or regain skills. And it may increase the risk of pneumonia and pressure sores. Hand feeding gives human contact and the pleasure of tasting favourite foods.
When death is near and patients can no longer be fed by hand, families/whānau often worry that the patient will “starve to death.” In fact, refusing food and water is a natural, non-painful part of the dying process. There is no good evidence that tube feeding helps these patients live longer.
Feeding tubes can have risks
- Tube feeding has many risks.
- It can cause bleeding, infection, skin irritation, or leaking around the tube.
- It can cause nausea, vomiting, and diarrhoea.
- The tube can get blocked or fall out, and must be replaced in a hospital.
- Many people with Alzheimer’s disease are bothered by the tube and try to pull it out. To prevent that, they are often tied down or given drugs.
- Tube-fed patients are more likely to get pressure sores.
- Tube-fed patients are more likely to spit up food, which may lead to pneumonia, a term called “aspiration pneumonia”.
- At the end of life, fluids can fill the patient’s lungs, and cause breathing problems.
So when are feeding tubes a good idea?
Feeding tubes can be helpful when the main cause of the eating problem is likely to get better. For example, they can help people who are recovering from a stroke, brain injury, or surgery. The tubes also make sense for people who have problems swallowing and are not in the last stage of an illness that can’t be cured. For example, they can help people with Parkinson’s disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Caring for a person with severe Alzheimer's disease
When caring for a person with severe Alzheimer’s disease, these steps can help with eating problems and other end-of-life concerns:
- Treat conditions that cause appetite loss, such as constipation, depression, or infection.
- Feed by hand. Ask a health professional about the best kinds of foods to offer and the best ways to feed by hand.
- Stop unneeded medicines. Some drugs can make eating problems worse, including:
- antipsychotics such as quetiapine (Seroquel and generic)
- sleeping pills or anti-anxiety drugs such as lorazepam or zopiclone
- bladder-control drugs such as oxybutynin
- some drugs for osteoporosis such as alendronate (Fosamax and generic)
- drugs for Alzheimer’s disease such as donepezil (Aricept and generic).
Schedule dental care. Badly fitting dentures, sore gums, and toothaches can make eating hard or painful.
Plan ahead. Every adult should have an advance directive. It lets you say what kind of care you want and who can make decisions for you if you cannot speak for yourself.
It’s OK to ask questions. If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Download this resource
© 2013 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057).Adapted from Consumer Reports (2013) and Choosing Wisely Canada (2014), Feeding tubes for people with Alzheimer’s disease, developed in cooperation with the Canadian Geriatrics Society.
Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
Blood tests
What is a blood transfusion?
A blood transfusion is a treatment arranged by your doctor. It involves giving you blood, or blood components, into a vein.
Where does blood come from?
In New Zealand, blood is obtained only from unpaid and voluntary donors.
How much blood do you need?
Getting a blood transfusion in the hospital can save your life. You may need a lot of blood if you are bleeding heavily because of an injury or illness.
But anaemia is usually not urgent. And usually you don’t need a lot of blood. You may only need one unit of blood while you are in the hospital. Or you may not need any blood at all. Here’s why:
What is anaemia?
If you have anaemia, your blood doesn’t have enough red blood cells, or they don’t work properly. Red blood cells carry h