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 haemoglobin. This is an iron-rich protein that helps bring oxygen to the body. Anaemia is measured in haemoglobin levels.
There are a number of reasons you may become anaemic while you are in the hospital, including:
- Bleeding
- Liver and kidney disease
- A chronic condition or disease
- Medications
- Kidney disease
- Chronic infections
- Cancer
Extra Units of blood are not helpful
In New Zealand, haemoglobin is measured in grams per litre of blood (g/L).
- The normal haemoglobin range for a man is between 130–170 g/L
- The normal haemoglobin range for a woman is between 120–160 g/L.
Some doctors believe that hospital patients whose haemoglobin falls below 100 g/dL should get a blood transfusion.
But recent research found that:
- Many patients with levels over 70g/L may not need a blood transfusion.
- One unit of blood is usually as good as two, and it may even be safer.
- Some patients in intensive care may do better when they receive less blood.
Using more blood units may increase risks
In New Zealand, the blood is generally very safe. The risks when you get blood are very small. They include:
- A minor allergic reaction (fever or rash) occurs in 1% to 2% of transfusions.
- A major reaction may cause kidney failure, breathing difficulties, and sometimes other life threatening complications. This is rare – there is roughly 1 case per year in NZ.
- Transfusion of blood products can sometimes cause an infection:
- Minor virus infections that are common in the community may sometimes be passed on.
- Infection with viruses such as Hepatitis B and C, and HIV/AIDS are very rare, but these infections are sometimes life-threatening. Tests on blood donations minimise the risk for these infections.
- For hepatitis B the risk is estimated as 1 in 300,000 transfusions (1 case every 2-3 years).
- The risks of acquiring hepatitis C, or HIV/AIDS is even lower (less than 1 in every 1,000,000 transfusions in New Zealand).
These problems can happen with any transfusion. But the risks are higher if you get more blood.
The supply of blood relies on donations
If you only use the blood you need, you are helping to keep a blood supply for other people.
Do patients ever need more than one unit of blood?
Most patients do well with just one unit of blood, if the transfusion is not for an emergency. But some people may need more blood. Discuss this with your doctor.
You may need more than one unit if:
- You have bleeding that is not well controlled, such as bleeding that continues during surgery.
- You have severe anaemia and unstable chest pain ('unstable' means that your symptoms keep changing).
Why was this resource developed?
This Choosing Wisely resource is based on the top five anaesthetic-related practices that, based on clinical evidence, may have limited benefit, no benefit or may potentially cause harm to patients, according to the Australian and New Zealand College of Anaesthetists, the Royal Australasian College of Surgeons, the Australian and New Zealand Intensive Care Society, and College of Intensive Care Medicine of Australia and New Zealand.
Choosing Wisely is a campaign to help health professionals and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high quality care.
Supporting evidence for the issues discussed in this resource
For a list of supporting evidence for the issues discussed in this resource, please see:
Having them every day may not be necessary
If you stay in a hospital overnight or longer, you may have many blood tests. Sometimes you need all the tests, especially if you are very sick. But sometimes you get more tests than you need. Here’s what you should know about blood tests in the hospital.
Common blood tests
When you’re in the hospital, you may have blood taken for two common tests:
- A full blood count (FBC) checks your blood for signs of infection, immune system problems, bleeding problems, and anaemia (low iron)
- A blood chemistry panel gives your doctor information about your muscles, bones, heart, and other organs. It also checks your blood sugar, calcium, and other minerals.
These tests can help your doctor identify a problem and learn if a treatment is working.
More testing doesn’t help you
If your test results stay the same after a day or two, you may not need them again. More tests won’t tell your doctor anything new, unless you’re in intensive care or your treatment changes.
Less testing doesn't hurt you
There’s no harm in having fewer tests. One study showed that reducing common tests at the hospital did not affect patient health or safety.
Getting too many blood tests has risks
Blood tests are very safe. But they can cause other problems if you have them every day.
- Anaemia. This can happen if you lose too much blood. With anaemia, your blood cells can’t carry enough oxygen to the rest of your body. Anaemia can make it harder for you to heal. It is especially dangerous for people with heart or lung problems.
- Increased risk of infection. Blood tests have a low risk of infection. But the more tests you have, the more risk you have.
- Less sleep. Nurses often wake patients up to get blood tests. Poor sleep can affect how you heal.
You may need a blood test every day if:
- you are in intensive care
- the doctors don’t know what’s wrong with you
- you are trying a new treatment
- your doctor thinks you may have internal bleeding, especially if you’re having surgery.
Other tests you may need
If you’re scheduled to have surgery, your doctor may want you to have certain tests. These are usually done before the day of your surgery. Consider the tests below only if you have certain problems or need some kinds of surgery:
- Blood coagulation test. May be needed if you’re having brain, cancer, heart, or spinal surgery. You may also need it if you have certain medical conditions or take blood thinners.
- Breathing test. Recommended if you’re having lung, chest, or upper abdominal surgery. You may also need it if you have lung disease or are short of breath.
- Cardiac stress test. May be needed if you have heart disease, especially if you are having major surgery.
- Chest X-ray. May be needed if you smoke, have symptoms of lung or heart disease, or are older than 70, especially if you’re having major surgery.
Download this resource
© 2015 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057).Adapted from Consumer Reports (2015), Blood tests when you’re in the hospital, developed in co-operation with the Society of Hospital Medicine.
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.
Anaemia in hospital – blood transfusions
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 haemoglobin. This is an iron-rich protein that helps bring oxygen to the body. Anaemia is measured in haemoglobin levels.
There are a number of reasons you may become anaemic while you are in the hospital, including:
- Bleeding
- Liver and kidney disease
- A chronic condition or disease
- Medications
- Kidney disease
- Chronic infections
- Cancer
Extra Units of blood are not helpful
In New Zealand, haemoglobin is measured in grams per litre of blood (g/L).
- The normal haemoglobin range for a man is between 130–170 g/L
- The normal haemoglobin range for a woman is between 120–160 g/L.
Some doctors believe that hospital patients whose haemoglobin falls below 100 g/dL should get a blood transfusion.
But recent research found that:
- Many patients with levels over 70g/L may not need a blood transfusion.
- One unit of blood is usually as good as two, and it may even be safer.
- Some patients in intensive care may do better when they receive less blood.
Using more blood units may increase risks
In New Zealand, the blood is generally very safe. The risks when you get blood are very small. They include:
- A minor allergic reaction (fever or rash) occurs in 1% to 2% of transfusions.
- A major reaction may cause kidney failure, breathing difficulties, and sometimes other life threatening complications. This is rare – there is roughly 1 case per year in NZ.
- Transfusion of blood products can sometimes cause an infection:
- Minor virus infections that are common in the community may sometimes be passed on.
- Infection with viruses such as Hepatitis B and C, and HIV/AIDS are very rare, but these infections are sometimes life-threatening. Tests on blood donations minimise the risk for these infections.
- For hepatitis B the risk is estimated as 1 in 300,000 transfusions (1 case every 2-3 years).
- The risks of acquiring hepatitis C, or HIV/AIDS is even lower (less than 1 in every 1,000,000 transfusions in New Zealand).
These problems can happen with any transfusion. But the risks are higher if you get more blood.
The supply of blood relies on donations
If you only use the blood you need, you are helping to keep a blood supply for other people.
Do patients ever need more than one unit of blood?
Most patients do well with just one unit of blood, if the transfusion is not for an emergency. But some people may need more blood. Discuss this with your doctor.
You may need more than one unit if:
- You have bleeding that is not well controlled, such as bleeding that continues during surgery.
- You have severe anaemia and unstable chest pain ('unstable' means that your symptoms keep changing).
Why was this resource developed?
This Choosing Wisely resource is based on the top five anaesthetic-related practices that, based on clinical evidence, may have limited benefit, no benefit or may potentially cause harm to patients, according to the Australian and New Zealand College of Anaesthetists, the Royal Australasian College of Surgeons, the Australian and New Zealand Intensive Care Society, and College of Intensive Care Medicine of Australia and New Zealand.
Choosing Wisely is a campaign to help health professionals and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high quality care.
Supporting evidence for the issues discussed in this resource
For a list of supporting evidence for the issues discussed in this resource, please see:
Having them every day may not be necessary
Having them every day may not be necessary
If you stay in a hospital overnight or longer, you may have many blood tests. Sometimes you need all the tests, especially if you are very sick. But sometimes you get more tests than you need. Here’s what you should know about blood tests in the hospital.
Common blood tests
When you’re in the hospital, you may have blood taken for two common tests:
- A full blood count (FBC) checks your blood for signs of infection, immune system problems, bleeding problems, and anaemia (low iron)
- A blood chemistry panel gives your doctor information about your muscles, bones, heart, and other organs. It also checks your blood sugar, calcium, and other minerals.
These tests can help your doctor identify a problem and learn if a treatment is working.
More testing doesn’t help you
If your test results stay the same after a day or two, you may not need them again. More tests won’t tell your doctor anything new, unless you’re in intensive care or your treatment changes.
Less testing doesn't hurt you
There’s no harm in having fewer tests. One study showed that reducing common tests at the hospital did not affect patient health or safety.
Getting too many blood tests has risks
Blood tests are very safe. But they can cause other problems if you have them every day.
- Anaemia. This can happen if you lose too much blood. With anaemia, your blood cells can’t carry enough oxygen to the rest of your body. Anaemia can make it harder for you to heal. It is especially dangerous for people with heart or lung problems.
- Increased risk of infection. Blood tests have a low risk of infection. But the more tests you have, the more risk you have.
- Less sleep. Nurses often wake patients up to get blood tests. Poor sleep can affect how you heal.
You may need a blood test every day if:
- you are in intensive care
- the doctors don’t know what’s wrong with you
- you are trying a new treatment
- your doctor thinks you may have internal bleeding, especially if you’re having surgery.
Other tests you may need
If you’re scheduled to have surgery, your doctor may want you to have certain tests. These are usually done before the day of your surgery. Consider the tests below only if you have certain problems or need some kinds of surgery:
- Blood coagulation test. May be needed if you’re having brain, cancer, heart, or spinal surgery. You may also need it if you have certain medical conditions or take blood thinners.
- Breathing test. Recommended if you’re having lung, chest, or upper abdominal surgery. You may also need it if you have lung disease or are short of breath.
- Cardiac stress test. May be needed if you have heart disease, especially if you are having major surgery.
- Chest X-ray. May be needed if you smoke, have symptoms of lung or heart disease, or are older than 70, especially if you’re having major surgery.
Download this resource
© 2015 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057).Adapted from Consumer Reports (2015), Blood tests when you’re in the hospital, developed in co-operation with the Society of Hospital Medicine.
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.
Imaging and diagnostics
A bone-density test is a way to measure the strength of your bones. The test, called a DEXA scan, is a kind of X-ray. The main reason to have the test is to find and treat serious bone loss, called osteoporosis, and prevent fractures and disability.
A DEXA scan measures the mineral density of the bone, usually in the hip and spine. Results are given as a “T-score”, which is your bone density compared to a normal young adult of the same sex.
Most men and women under age 65 probably don’t need the test because:
- Most people do not have serious bone loss
Most people have no bone loss or have mild bone loss (called osteopenia). Their risk of breaking a bone is low so they do not need the test. They should exercise regularly and get plenty of calcium and vitamin D. This is the best way to prevent bone loss.
- The bone-density scan has risks
A bone-density test gives out a small amount of radiation, but radiation exposure can add up. The effects can add up in your body over your life, so it is best to avoid it if you can.
Who should get a bone-density scan?
Women should get a DEXA scan at age 65, and men age 70 and up. They may want to talk with their health care providers about the risks and benefits before deciding. Younger women and men ages 50 to 69 should consider the test if they have risk factors for serious bone loss. Common risk factors include:
- breaking a bone in a minor accident
- having rheumatoid arthritis
- having a parent who broke a hip
- smoking or drinking excess alcohol
- having a low body weight
- using corticosteroid drugs for three months or more.
You may need a follow-up bone-density test after several years
Most changes in bone density do not happen quickly. There is often no benefit having a follow-up DEXA scan for at least 5 years. If your T score from your first scan was 2.00 or more, you do not need another scan for 5 years. You may need a follow-up scan sooner if you have risk factors for bone loss, such as:
- hyperparathyroidism (where your parathyroid gland is over-active)
- taking certain medicines, such as steroids, or hormones for treating breast or prostate cancer
- Low levels of vitamin D.
How can you keep your bones strong?
The following steps can help you build bone:
- The best exercise for your bones is exercise that makes your bones carry weight. When you walk, your bones carry the weight of your whole body. You can also lift weights. Aim for at least 30 minutes of weight-bearing exercise a day
- Get enough calcium and vitamin D. They help keep your bones strong. Aim for at least 1,200 mg of calcium a day. Eat foods high in calcium, such as dairy products, leafy green vegetables, and canned sardines and salmon. You may need a calcium pill each day. Consider taking vitamin D if you are a woman in menopause or you get little sun. Take 800 IU a day.
- Avoid smoking and limit alcohol. Among other things, smoking and drinking alcohol can speed up bone loss. Quitting smoking can be difficult, but there are many treatments that can help you do it. Ask your health care provider or contact Quitline on 0800 778 778. For alcohol, limit yourself to one drink a day for women, and two drinks a day for men.
- Try to avoid certain medicines. Some medicines can damage bones. These include proton pump inhibitors (such as omeprazole, lansoprazole, and pantoprazole), used to treat heartburn; corticosteroids; and some of the newer antidepressants. If you take one of these medicines, ask your health care provider about whether these medications are right for you.
Why was this resource developed?
This Choosing Wisely resource is based on the top five practices that, based on clinical evidence, may have limited benefit, no benefit or may potentially cause harm, according to the New Zealand Association of Rheumatologists[1].
Choosing Wisely is a campaign to help health professionals and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high quality care.
Supporting evidence for the issues discussed in this resource
For a list of supporting evidence for the issues discussed in this resource, please see: https://www.hqsc.govt.nz/our-programmes/other-topics/choosing-wisely/recommendations-and-resources/for-clinicians/new-zealand-rheumatology-association-nzra
Ask these questions
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler, safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen—or get better—if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a conversation with your health professional today.
Download this resource
Developed by Choosing Wisely New Zealand, 2018. Adapted from Choosing Wisely Canada and Choosing Wisely USA/Consumer Reports (2016) “Bone density tests: when you need them and when you don’t” and BPAC New Zealand (2008) “Prevention of Osteoporosis”. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. 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.
The exact cause of your acute low back pain may be difficult to identify but in most cases it is related to things like muscle strain rather than conditions like nerve or bone damage, infection or cancer. Talk to your health professional about how to manage your low back pain.
The problem
Getting an X-ray, CT scan or MRI may seem like a good idea. But back pain usually subsides in about a month, with or without testing. For example, one study found that back pain sufferers who had an MRI in the first month were eight times more likely to have surgery, but didn’t recover faster.
The risks
X-rays and CT scans expose you to radiation, which can increase cancer risk. CT scans and X-rays of the lower back are especially worrisome for men and women of childbearing age, because they can expose testicles and ovaries to substantial radiation. Finally, the tests often reveal abnormalities that are unrelated to the pain, but can prompt needless worry and lead to unnecessary follow-up tests and treatment, sometimes even including surgery.
When to consider the tests
X-ray and CT scans often make sense if you have nerve damage, or signs of a serious underlying condition such as cancer or a spinal infection. “Red flags” that can alert your health professional that imaging may be worthwhile include a history of cancer, unexplained weight loss, recent infection, loss of bowel or bladder control, abnormal reflexes, or loss of muscle power or feeling in the legs.
Ask these questions
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen—or get better—if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a conversation with your health professional today.
Download this resource
© 2014 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2014) and Choosing Wisely Canada (2014), Common tests, treatments and procedures you may think you need. Let’s think again.
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.
About medical imaging
The ankle and knee are joints located in the lower leg. Injuries to these joints are very common reasons why people visit their GP or physiotherapist. Injuries that frequently affect these joints include ligament sprains, muscle and tendon strains, and damage to the meniscus (cartilage) in the knee.
Although these injuries are often painful and uncomfortable, they can usually be managed with rest, ice, support and a gradual return to physical activity.
In some cases, such as when the cause of the injury is unclear or the damage to the joint is complex, an imaging test, such as an X-ray, ultrasound or magnetic resonance imaging (MRI), may be recommended. However, research shows that in most cases of acute ankle and knee sprain/strain, having an X-ray or MRI does not change the treatment you receive or how fast you recover. In addition, having an X-ray you don’t need may expose you to unnecessary radiation.
In fact, for many sprains affecting the ankles and knees, taking a history and examining the joint is all that your health professional will need to do to determine the diagnosis and guide management.
Factsheets
Ankle sprains: 10 things to know
Read 10 things you should know about ankle sprains on the NPS MedicineWise website to help you get back moving as usual.
Your knee joint injury, explained
The knee is a commonly injured part of the body. In fact, in sport it’s the most commonly injured part, with research finding that up to one in four of all sport injuries affect the knee.
Different types of medical imaging
There are several types of medical imaging tests, each with its own advantages and disadvantages. Read Know your imaging options on the NPS MedicineWise website to be informed about your medical imaging test and talk to your health professional about any questions or concerns you may have.
Questions you can ask about medical imaging
Imaging can be very useful in helping to diagnose the cause of your symptoms, but is not always necessary. Read Talking to your health professional about imaging on the NPS MedicineWise website to be well informed about your imaging and ask your doctor any questions you may have.
For more information: Health Navigator.
It's OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Adapted from NPS MedicineWise (2016), Ankle and knee imaging. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.
The problem
An ECG records the electrical activity of your heart at rest. It provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure (hypertension) or evidence of a previous heart attack (myocardial infarction).
The risks
The ECG will not harm you. However, it can sometimes show mild nonspecific abnormalities that are not due to underlying heart disease, but cause worry and lead to follow-up tests and treatments that you do not need.
When to consider the tests
You may need an ECG test if you have risk factors for heart disease such as high blood pressure, or symptoms such as palpitations or chest pain. Or you may need it if you already have heart disease.
Ask these questions:
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler, safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen—or get better—if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a conversation with your health professional today.
Download this resource
© 2014 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2014) and Choosing Wisely Canada (2014), Common tests, treatments and procedures you may think you need. Let’s think again.
Choosing Wisely do not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
CT and MRI examinations are called imaging tests because they take pictures, or images, of the inside of the body. Many people who have headaches want a CT scan or an MRI to find out if their headaches are caused by a serious problem, such as a brain tumor. Most of the time these tests are not needed. Here’s why:
Imaging tests rarely help
Health professionals see many patients for headaches and most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful, but a CT scan or an MRI rarely shows why the headache occurs. Having a CT scan or MRI also does not help ease the pain.
A health professional can diagnose most headaches during an office visit. They ask you questions about your health and your symptoms. This is called a medical history. Then they may do what is called a neurological exam, which includes a test of your reflexes. If your medical history and exam are normal, usually imaging tests will not show a serious problem.
Imaging tests have risks
A CT scan of the head uses a low radiation dose. This may slightly increase the risk of harmful effects such as cancer. Risks from radiation exposure may add up, so it is best to avoid unnecessary radiation.
The results of your CT scan or an MRI may also be unclear. This can lead to more tests and even treatment that you do not need.
When should you have an imaging test for headaches?
In some cases you might need a CT scan or an MRI. You might need one if your health professional cannot diagnose your headache based on your neurological exam and medical history. Or you might need one if the exam finds something that is not normal.
You may also need a CT scan or an MRI if you have unusual headaches. See your health professional right away if:
- You suddenly develop a very severe headache which feels like something is bursting inside your head.
- Your headaches are different from other headaches you’ve had, especially if you are age 50 or older.
- Your headaches happen after you have been physically active.
- You have headaches with other serious symptoms, such as a loss of control, a seizure or fit, or a change in speech or alertness.
How to treat a headache
Your health professional can advise you on how best to treat your headache. You can help most headaches by taking these steps:
Avoid triggers. Triggers are events that can cause headaches. These tips can help you avoid triggers:
If you have migraines:
- Wear tinted glasses in bright light
- Do not skip meals
- Avoid alcohol, meat with added nitrates (such as cold cuts), and aged cheeses (hard, dry cheeses such as parmesan).
If you have tension headaches:
- Avoid getting over tired
- Hold your back and neck straight when you sit or stand
- Keep your jaw relaxed (not clenched).
Quit smoking. Smoking can bring on either kind of headache.
Manage stress. Try meditation, yoga, stretching, or other activities that can help you relax.
Get plenty of sleep. Aim for six to eight hours of sleep each night. Set a regular time to go to bed and to wake up. Avoid watching TV or using a computer just before you go to bed.
Get plenty of exercise. Regular exercise, such as swimming, brisk walking, or cycling, can reduce stress and ease both kinds of headaches.
Non-prescription pain medicines such as the following can help:
- paracetamol
- ibuprofen
- naproxen
You can buy all of these without a prescription. Try not to take any of these pills more than once or twice a week. Overuse can make headaches worse and cause side effects.
If your headaches are severe or happen often, there are medications which your health professional can prescribe to help lower the pain level and/or reduce how frequently you get them.
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
© 2016 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057).Adapted from Consumer Reports (2016) and Choosing Wisely Canada (2014), Imaging tests for headaches, developed in cooperation with the Canadian Association of Radiologists. 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.
Bone density (DEXA) scans
A bone-density test is a way to measure the strength of your bones. The test, called a DEXA scan, is a kind of X-ray. The main reason to have the test is to find and treat serious bone loss, called osteoporosis, and prevent fractures and disability.
A DEXA scan measures the mineral density of the bone, usually in the hip and spine. Results are given as a “T-score”, which is your bone density compared to a normal young adult of the same sex.
Most men and women under age 65 probably don’t need the test because:
- Most people do not have serious bone loss
Most people have no bone loss or have mild bone loss (called osteopenia). Their risk of breaking a bone is low so they do not need the test. They should exercise regularly and get plenty of calcium and vitamin D. This is the best way to prevent bone loss.
- The bone-density scan has risks
A bone-density test gives out a small amount of radiation, but radiation exposure can add up. The effects can add up in your body over your life, so it is best to avoid it if you can.
Who should get a bone-density scan?
Women should get a DEXA scan at age 65, and men age 70 and up. They may want to talk with their health care providers about the risks and benefits before deciding. Younger women and men ages 50 to 69 should consider the test if they have risk factors for serious bone loss. Common risk factors include:
- breaking a bone in a minor accident
- having rheumatoid arthritis
- having a parent who broke a hip
- smoking or drinking excess alcohol
- having a low body weight
- using corticosteroid drugs for three months or more.
You may need a follow-up bone-density test after several years
Most changes in bone density do not happen quickly. There is often no benefit having a follow-up DEXA scan for at least 5 years. If your T score from your first scan was 2.00 or more, you do not need another scan for 5 years. You may need a follow-up scan sooner if you have risk factors for bone loss, such as:
- hyperparathyroidism (where your parathyroid gland is over-active)
- taking certain medicines, such as steroids, or hormones for treating breast or prostate cancer
- Low levels of vitamin D.
How can you keep your bones strong?
The following steps can help you build bone:
- The best exercise for your bones is exercise that makes your bones carry weight. When you walk, your bones carry the weight of your whole body. You can also lift weights. Aim for at least 30 minutes of weight-bearing exercise a day
- Get enough calcium and vitamin D. They help keep your bones strong. Aim for at least 1,200 mg of calcium a day. Eat foods high in calcium, such as dairy products, leafy green vegetables, and canned sardines and salmon. You may need a calcium pill each day. Consider taking vitamin D if you are a woman in menopause or you get little sun. Take 800 IU a day.
- Avoid smoking and limit alcohol. Among other things, smoking and drinking alcohol can speed up bone loss. Quitting smoking can be difficult, but there are many treatments that can help you do it. Ask your health care provider or contact Quitline on 0800 778 778. For alcohol, limit yourself to one drink a day for women, and two drinks a day for men.
- Try to avoid certain medicines. Some medicines can damage bones. These include proton pump inhibitors (such as omeprazole, lansoprazole, and pantoprazole), used to treat heartburn; corticosteroids; and some of the newer antidepressants. If you take one of these medicines, ask your health care provider about whether these medications are right for you.
Why was this resource developed?
This Choosing Wisely resource is based on the top five practices that, based on clinical evidence, may have limited benefit, no benefit or may potentially cause harm, according to the New Zealand Association of Rheumatologists[1].
Choosing Wisely is a campaign to help health professionals and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high quality care.
Supporting evidence for the issues discussed in this resource
For a list of supporting evidence for the issues discussed in this resource, please see: https://www.hqsc.govt.nz/our-programmes/other-topics/choosing-wisely/recommendations-and-resources/for-clinicians/new-zealand-rheumatology-association-nzra
Ask these questions
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler, safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen—or get better—if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a conversation with your health professional today.
Download this resource
Developed by Choosing Wisely New Zealand, 2018. Adapted from Choosing Wisely Canada and Choosing Wisely USA/Consumer Reports (2016) “Bone density tests: when you need them and when you don’t” and BPAC New Zealand (2008) “Prevention of Osteoporosis”. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. 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.
Back pain - imaging tests
The exact cause of your acute low back pain may be difficult to identify but in most cases it is related to things like muscle strain rather than conditions like nerve or bone damage, infection or cancer. Talk to your health professional about how to manage your low back pain.
The problem
Getting an X-ray, CT scan or MRI may seem like a good idea. But back pain usually subsides in about a month, with or without testing. For example, one study found that back pain sufferers who had an MRI in the first month were eight times more likely to have surgery, but didn’t recover faster.
The risks
X-rays and CT scans expose you to radiation, which can increase cancer risk. CT scans and X-rays of the lower back are especially worrisome for men and women of childbearing age, because they can expose testicles and ovaries to substantial radiation. Finally, the tests often reveal abnormalities that are unrelated to the pain, but can prompt needless worry and lead to unnecessary follow-up tests and treatment, sometimes even including surgery.
When to consider the tests
X-ray and CT scans often make sense if you have nerve damage, or signs of a serious underlying condition such as cancer or a spinal infection. “Red flags” that can alert your health professional that imaging may be worthwhile include a history of cancer, unexplained weight loss, recent infection, loss of bowel or bladder control, abnormal reflexes, or loss of muscle power or feeling in the legs.
Ask these questions
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen—or get better—if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a conversation with your health professional today.
Download this resource
© 2014 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2014) and Choosing Wisely Canada (2014), Common tests, treatments and procedures you may think you need. Let’s think again.
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.
Ankle and knee imaging
About medical imaging
The ankle and knee are joints located in the lower leg. Injuries to these joints are very common reasons why people visit their GP or physiotherapist. Injuries that frequently affect these joints include ligament sprains, muscle and tendon strains, and damage to the meniscus (cartilage) in the knee.
Although these injuries are often painful and uncomfortable, they can usually be managed with rest, ice, support and a gradual return to physical activity.
In some cases, such as when the cause of the injury is unclear or the damage to the joint is complex, an imaging test, such as an X-ray, ultrasound or magnetic resonance imaging (MRI), may be recommended. However, research shows that in most cases of acute ankle and knee sprain/strain, having an X-ray or MRI does not change the treatment you receive or how fast you recover. In addition, having an X-ray you don’t need may expose you to unnecessary radiation.
In fact, for many sprains affecting the ankles and knees, taking a history and examining the joint is all that your health professional will need to do to determine the diagnosis and guide management.
Factsheets
Ankle sprains: 10 things to know
Read 10 things you should know about ankle sprains on the NPS MedicineWise website to help you get back moving as usual.
Your knee joint injury, explained
The knee is a commonly injured part of the body. In fact, in sport it’s the most commonly injured part, with research finding that up to one in four of all sport injuries affect the knee.
Different types of medical imaging
There are several types of medical imaging tests, each with its own advantages and disadvantages. Read Know your imaging options on the NPS MedicineWise website to be informed about your medical imaging test and talk to your health professional about any questions or concerns you may have.
Questions you can ask about medical imaging
Imaging can be very useful in helping to diagnose the cause of your symptoms, but is not always necessary. Read Talking to your health professional about imaging on the NPS MedicineWise website to be well informed about your imaging and ask your doctor any questions you may have.
For more information: Health Navigator.
It's OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Adapted from NPS MedicineWise (2016), Ankle and knee imaging. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.
Electrocardiogram (ECGs)
The problem
An ECG records the electrical activity of your heart at rest. It provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure (hypertension) or evidence of a previous heart attack (myocardial infarction).
The risks
The ECG will not harm you. However, it can sometimes show mild nonspecific abnormalities that are not due to underlying heart disease, but cause worry and lead to follow-up tests and treatments that you do not need.
When to consider the tests
You may need an ECG test if you have risk factors for heart disease such as high blood pressure, or symptoms such as palpitations or chest pain. Or you may need it if you already have heart disease.
Ask these questions:
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler, safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen—or get better—if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a conversation with your health professional today.
Download this resource
© 2014 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2014) and Choosing Wisely Canada (2014), Common tests, treatments and procedures you may think you need. Let’s think again.
Choosing Wisely do not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
Headaches
CT and MRI examinations are called imaging tests because they take pictures, or images, of the inside of the body. Many people who have headaches want a CT scan or an MRI to find out if their headaches are caused by a serious problem, such as a brain tumor. Most of the time these tests are not needed. Here’s why:
Imaging tests rarely help
Health professionals see many patients for headaches and most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful, but a CT scan or an MRI rarely shows why the headache occurs. Having a CT scan or MRI also does not help ease the pain.
A health professional can diagnose most headaches during an office visit. They ask you questions about your health and your symptoms. This is called a medical history. Then they may do what is called a neurological exam, which includes a test of your reflexes. If your medical history and exam are normal, usually imaging tests will not show a serious problem.
Imaging tests have risks
A CT scan of the head uses a low radiation dose. This may slightly increase the risk of harmful effects such as cancer. Risks from radiation exposure may add up, so it is best to avoid unnecessary radiation.
The results of your CT scan or an MRI may also be unclear. This can lead to more tests and even treatment that you do not need.
When should you have an imaging test for headaches?
In some cases you might need a CT scan or an MRI. You might need one if your health professional cannot diagnose your headache based on your neurological exam and medical history. Or you might need one if the exam finds something that is not normal.
You may also need a CT scan or an MRI if you have unusual headaches. See your health professional right away if:
- You suddenly develop a very severe headache which feels like something is bursting inside your head.
- Your headaches are different from other headaches you’ve had, especially if you are age 50 or older.
- Your headaches happen after you have been physically active.
- You have headaches with other serious symptoms, such as a loss of control, a seizure or fit, or a change in speech or alertness.
How to treat a headache
Your health professional can advise you on how best to treat your headache. You can help most headaches by taking these steps:
Avoid triggers. Triggers are events that can cause headaches. These tips can help you avoid triggers:
If you have migraines:
- Wear tinted glasses in bright light
- Do not skip meals
- Avoid alcohol, meat with added nitrates (such as cold cuts), and aged cheeses (hard, dry cheeses such as parmesan).
If you have tension headaches:
- Avoid getting over tired
- Hold your back and neck straight when you sit or stand
- Keep your jaw relaxed (not clenched).
Quit smoking. Smoking can bring on either kind of headache.
Manage stress. Try meditation, yoga, stretching, or other activities that can help you relax.
Get plenty of sleep. Aim for six to eight hours of sleep each night. Set a regular time to go to bed and to wake up. Avoid watching TV or using a computer just before you go to bed.
Get plenty of exercise. Regular exercise, such as swimming, brisk walking, or cycling, can reduce stress and ease both kinds of headaches.
Non-prescription pain medicines such as the following can help:
- paracetamol
- ibuprofen
- naproxen
You can buy all of these without a prescription. Try not to take any of these pills more than once or twice a week. Overuse can make headaches worse and cause side effects.
If your headaches are severe or happen often, there are medications which your health professional can prescribe to help lower the pain level and/or reduce how frequently you get them.
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
© 2016 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057).Adapted from Consumer Reports (2016) and Choosing Wisely Canada (2014), Imaging tests for headaches, developed in cooperation with the Canadian Association of Radiologists. 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.
Antibiotics
Manage symptoms without antibiotics
If you have a viral infection of the ear, nose, throat, sinuses or chest, antibiotics won’t make you feel better or recover faster. Talk to your health professional about why you probably don’t need antibiotics.
Do you need a medicine?
Coughs, colds, earaches, sinus congestion problems and sore throats are usually caused by a virus. Antibiotics kill bacteria, not viruses. Colds usually get better in 7 to 10 days, although a cough can last up to 3 weeks.
Taking antibiotics when you don’t need them can have unwanted results. When antibiotics are necessary, the benefits far outweigh the risks, but when they are not needed, you are taking an unnecessary risk. People taking an antibiotic may experience side effects such as diarrhoea, nausea or vomiting.
Unnecessary use of antibiotics can also lead to antibiotic resistance. This means that antibiotics are no longer effective against the bacteria they once killed. If you have an antibiotic-resistant infection you:
- will have the infection for longer
- may be more likely to have complications of the infection
- could remain infectious for longer and pass your infection to other people.
What can you do?
Rest
Allow your immune system to fight off the virus
Use home remedies
Inhale steam from a bath or shower in a closed room to help relieve a blocked nose. Don’t inhale steam from a bowl of hot water due to the risk of burns. Soothe your sore throat by gargling warm salty water, sucking ice cubes or throat lozenges as needed or drinking warm water with honey and lemon.
Use symptom-relieving medicines
Take over-the-counter (non-prescription) medicines such as paracetamol or ibuprofen to relieve your pain or fever.
Use a nasal or oral decongestant to relieve a blocked nose. Cough and cold medicines should not be given to children under 6 years of age and should only be given to children aged 6 to 11 years on the advice of a health professional. Saline nasal spray or drops may be used in children. For more information on symptom-relieving medicines see the Choosing Wisely resource on medicines and treatments for bronchitis.
It's OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Further information
Antibiotics: Health Navigator
Antibiotic resistance: Health Navigator, Ministry of Health
Download this resource
Adapted from NPS MedicineWise (2016), Coughs, colds & sore throats. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.
The problem
People with sinusitis (congestion combined with nasal discharge and facial pain) are often prescribed antibiotics. But most people don’t need them. That’s because the problem almost always stems from a viral infection, not a bacterial one—and antibiotics don’t work against viruses.
The risks
About one in four people who take antibiotics report side effects, such as a rash, dizziness and stomach problems. In rare cases, they can cause severe allergic reactions. Overuse of antibiotics also encourages the growth of bacteria that can’t be controlled easily with drugs. That makes you more vulnerable to antibiotic-resistant infections and undermines the usefulness of antibiotics for everyone.
When to consider antibiotics
Antibiotics should usually only be considered when symptoms last longer than a week, start to improve but then worsen again, or are very severe. Worrisome symptoms that can warrant immediate antibiotic treatment include a fever over 38.6°C, extreme pain and tenderness over your sinuses, or signs of a skin infection, such as a hot, red rash that spreads quickly.
Ask these questions
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen — or get better — if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a healthy conversation with your health professional today.
It's OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Further information
Antibiotics: Health Navigator
Antibiotic resistance: Health Navigator, Ministry of Health
Download this resource
© 2014 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2014) and Choosing Wisely Canada (2014), Common tests, treatments and procedures you may think you need. Let’s think again. 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.
When you need them and when you don't
Sometimes rashes and surgical wounds become infected with bacteria. Doctors treat these infections with antibiotics, which are medicines that can kill bacteria.However, doctors may prescribe antibiotics even when there is no infection. Most of the time, that’s not useful, and it can do more harm than good. Here’s why:
Antibiotics usually don't help if your skin is not infected
Eczema causes dry, itchy, red skin. People with eczema often have high amounts of bacteria on their skin, but that doesn’t mean they have an infection. Even so, some doctors treat eczema with oral antibiotics, in pill or liquid form. Antibiotics do not help the itching, redness, or severity of eczema. And the skin bacteria usually come back in a month or two. You can control eczema better with moisturisers and the other steps below. To relieve itching and swelling, ask your doctor about creams or ointments containing a steroid (also called a corticosteroid) or other medicines.
Most surgical wounds don’t need antibiotics
Some doctors use antibiotic creams or ointments to prevent infection in surgical wounds. However, most surgical wounds have a very low risk of infection. Antibiotics don’t make the risk any lower. In fact, petroleum jelly (Vaseline and generic) is cheaper and less likely to irritate the wound.
Antibiotics have risks
Oral antibiotics for eczema can have side effects, including upset stomach, vomiting, diarrhoea, and vaginal yeast infections. They can also cause allergic reactions such as rashes, swelling, itching, and trouble breathing.
Antibiotic creams and ointments can actually slow down the healing of wounds. And they can cause redness, swelling, blistering, draining, and itching. Using antibiotics when you don’t need them helps drug-resistant bacteria grow. These bacteria are harder to kill. They can cause illnesses that are harder to cure. This increases the risk of complications and side effects. The resistant bacteria can also be passed on to others.
When do you need antibiotics?
Antibiotics should be prescribed for eczema when there are signs of a bacterial infection, such as:
- Pus-filled bumps, or cracks and sores that ooze pus
- Honey-colored crusting
- Very red or unusually warm skin
- Possibly fever
Antibiotics should be prescribed for surgical wounds:
- when the wound shows signs of a bacterial infection, such as redness, pain, swelling, warmth, pus, oozing, and yellow crusting
- sometimes when a patient has a fever, sweats, or chills
- when the wound is in an area of the body that is more likely to get infected (such as the groin).
Safeguard your skin
Eczema
- Moisturise often during the day.
- Use mild unscented skin cleansers and moisturisers. Avoid products with alcohol or dyes.
- Short, cooler baths and showers are better than long hot soaks.
- After washing, pat the skin partly dry. Then apply moisturiser right away on your damp skin.
- Avoid things that make your skin worse. These can include scratchy fabrics, cigarette smoke, strong soaps, detergents and cleaning products.
- Try to prevent scratching. It can lead to infection. Cut your fingernails short. Light cotton gloves can help prevent scratching at night.
Surgical wounds
- Before you leave the hospital or doctor’s office, make sure you know how to care for your wound. Ask where to call if you have questions.
- Always clean your hands before and after caring for your wound.
- Don’t scratch the wound. That can slow the healing. Talk to your health professional if itching is a problem.
- Avoid activities that could cause your wound to pull apart, such as lifting and straining.
- Eat well to heal well. A healthy diet helps wounds heal.
Further information
Antibiotics: Health Navigator
Antibiotic resistance: Health Navigator, Ministry of Health
This report is for you to use when talking with your health professional.
Download this resource
© 2016 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2016), Antibiotics for your skin. When you need them — and when you don’t, developed in co-operation with the American Academy of Dermatology.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.
A middle ear infection (otitis media) will often get better by itself in a few days as the body’s immune system can take care of the infection without any treatment.
Children with a middle ear infection
Most children older than 2 years won’t need antibiotics to treat a middle ear infection — the infection will clear up by itself in a few days. However, many children younger than 2 years may need antibiotics to treat the infection. Antibiotics won’t help relieve your child’s ear pain. Whilst a child’s ear pain will be of concern to their parents or carers, studies show that 6 out of 10 children will have no ear pain after the first 24 hours without any treatment (antibiotics or pain relief). Pain relief medicines (such as paracetamol or ibuprofen) can help to relieve the symptoms of an ear infection, and will usually only be needed for a short time.
If your child’s symptoms don’t improve after a few days, or their symptoms get worse, see your doctor.
Antibiotics for middle ear infections in children
Antibiotics are recommended for children with middle ear infections who:
- are younger than 6 months
- are younger than 2 years old with an infection in both ears or fluid leaking out of their ear (called ‘otorrhoea’)
- have a fever (a temperature of 38.5°C or higher) and are vomiting.
Babies and infants younger than 6 months old
Infants younger than 6 months old who have ear infections (with or without fever or vomiting) will usually be prescribed an antibiotic. Your doctor will usually ask to see your baby again in 24 hours.
Children aged 6 months to 2 years
Your doctor will advise you on how to relieve the symptoms of a middle ear infection.. Your doctor may ask to see your child after 24 hours, or contact you to ask how they are. If your child’s symptoms don’t improve after 24 hours, your doctor may prescribe antibiotics.
Children aged 2 years or older
Your doctor will advise you on how to relieve the symptoms of a middle ear infection.. If your child’s symptoms don’t improve in 2 days, your doctor will usually examine your child again and may prescribe antibiotics if necessary.
Adults with a middle ear infection
Most adults won’t need antibiotics to treat a middle ear infection — the infection will clear up by itself in a few days.
Your doctor can provide advice about how to relieve your symptoms. If your symptoms don’t improve in 2 days, your doctor will usually examine you again and may prescribe antibiotics.
Paracetamol, ibuprofen or aspirin can help relieve the pain caused by an ear infection.
For more information: Health Navigator.
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 NPS MedicineWise (2016), Medicines and treatments for a middle ear infection. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.
Antibiotics - coughs, colds & sore throats
Manage symptoms without antibiotics
If you have a viral infection of the ear, nose, throat, sinuses or chest, antibiotics won’t make you feel better or recover faster. Talk to your health professional about why you probably don’t need antibiotics.
Do you need a medicine?
Coughs, colds, earaches, sinus congestion problems and sore throats are usually caused by a virus. Antibiotics kill bacteria, not viruses. Colds usually get better in 7 to 10 days, although a cough can last up to 3 weeks.
Taking antibiotics when you don’t need them can have unwanted results. When antibiotics are necessary, the benefits far outweigh the risks, but when they are not needed, you are taking an unnecessary risk. People taking an antibiotic may experience side effects such as diarrhoea, nausea or vomiting.
Unnecessary use of antibiotics can also lead to antibiotic resistance. This means that antibiotics are no longer effective against the bacteria they once killed. If you have an antibiotic-resistant infection you:
- will have the infection for longer
- may be more likely to have complications of the infection
- could remain infectious for longer and pass your infection to other people.
What can you do?
Rest
Allow your immune system to fight off the virus
Use home remedies
Inhale steam from a bath or shower in a closed room to help relieve a blocked nose. Don’t inhale steam from a bowl of hot water due to the risk of burns. Soothe your sore throat by gargling warm salty water, sucking ice cubes or throat lozenges as needed or drinking warm water with honey and lemon.
Use symptom-relieving medicines
Take over-the-counter (non-prescription) medicines such as paracetamol or ibuprofen to relieve your pain or fever.
Use a nasal or oral decongestant to relieve a blocked nose. Cough and cold medicines should not be given to children under 6 years of age and should only be given to children aged 6 to 11 years on the advice of a health professional. Saline nasal spray or drops may be used in children. For more information on symptom-relieving medicines see the Choosing Wisely resource on medicines and treatments for bronchitis.
It's OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Further information
Antibiotics: Health Navigator
Antibiotic resistance: Health Navigator, Ministry of Health
Download this resource
Adapted from NPS MedicineWise (2016), Coughs, colds & sore throats. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.
Antibiotics for sinusitis
The problem
People with sinusitis (congestion combined with nasal discharge and facial pain) are often prescribed antibiotics. But most people don’t need them. That’s because the problem almost always stems from a viral infection, not a bacterial one—and antibiotics don’t work against viruses.
The risks
About one in four people who take antibiotics report side effects, such as a rash, dizziness and stomach problems. In rare cases, they can cause severe allergic reactions. Overuse of antibiotics also encourages the growth of bacteria that can’t be controlled easily with drugs. That makes you more vulnerable to antibiotic-resistant infections and undermines the usefulness of antibiotics for everyone.
When to consider antibiotics
Antibiotics should usually only be considered when symptoms last longer than a week, start to improve but then worsen again, or are very severe. Worrisome symptoms that can warrant immediate antibiotic treatment include a fever over 38.6°C, extreme pain and tenderness over your sinuses, or signs of a skin infection, such as a hot, red rash that spreads quickly.
Ask these questions
Do I really need to have this test, treatment or procedure?
The answer should be direct and simple. Tests should help you and your health professional decide how to treat your problem, and treatments and procedures should help you live a longer, healthier life.
What are the risks (of having or not having it)?
Discuss the risks as well as the chance of inaccurate results or findings that will never cause symptoms, but may require further testing. Weigh the potential complications against possible benefits and the symptoms of the condition itself.
Are there simpler safer options?
Sometimes lifestyle changes will provide all the relief you need.
What happens if I do nothing?
Ask your health professional if your condition might worsen — or get better — if you don’t have the test or treatment now.
There may be tests, treatments and procedures you think you need, but you don’t. Let’s think again. Engage in a healthy conversation with your health professional today.
It's OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Further information
Antibiotics: Health Navigator
Antibiotic resistance: Health Navigator, Ministry of Health
Download this resource
© 2014 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2014) and Choosing Wisely Canada (2014), Common tests, treatments and procedures you may think you need. Let’s think again. 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.
Antibiotics for your skin
When you need them and when you don't
Sometimes rashes and surgical wounds become infected with bacteria. Doctors treat these infections with antibiotics, which are medicines that can kill bacteria.However, doctors may prescribe antibiotics even when there is no infection. Most of the time, that’s not useful, and it can do more harm than good. Here’s why:
Antibiotics usually don't help if your skin is not infected
Eczema causes dry, itchy, red skin. People with eczema often have high amounts of bacteria on their skin, but that doesn’t mean they have an infection. Even so, some doctors treat eczema with oral antibiotics, in pill or liquid form. Antibiotics do not help the itching, redness, or severity of eczema. And the skin bacteria usually come back in a month or two. You can control eczema better with moisturisers and the other steps below. To relieve itching and swelling, ask your doctor about creams or ointments containing a steroid (also called a corticosteroid) or other medicines.
Most surgical wounds don’t need antibiotics
Some doctors use antibiotic creams or ointments to prevent infection in surgical wounds. However, most surgical wounds have a very low risk of infection. Antibiotics don’t make the risk any lower. In fact, petroleum jelly (Vaseline and generic) is cheaper and less likely to irritate the wound.
Antibiotics have risks
Oral antibiotics for eczema can have side effects, including upset stomach, vomiting, diarrhoea, and vaginal yeast infections. They can also cause allergic reactions such as rashes, swelling, itching, and trouble breathing.
Antibiotic creams and ointments can actually slow down the healing of wounds. And they can cause redness, swelling, blistering, draining, and itching. Using antibiotics when you don’t need them helps drug-resistant bacteria grow. These bacteria are harder to kill. They can cause illnesses that are harder to cure. This increases the risk of complications and side effects. The resistant bacteria can also be passed on to others.
When do you need antibiotics?
Antibiotics should be prescribed for eczema when there are signs of a bacterial infection, such as:
- Pus-filled bumps, or cracks and sores that ooze pus
- Honey-colored crusting
- Very red or unusually warm skin
- Possibly fever
Antibiotics should be prescribed for surgical wounds:
- when the wound shows signs of a bacterial infection, such as redness, pain, swelling, warmth, pus, oozing, and yellow crusting
- sometimes when a patient has a fever, sweats, or chills
- when the wound is in an area of the body that is more likely to get infected (such as the groin).
Safeguard your skin
Eczema
- Moisturise often during the day.
- Use mild unscented skin cleansers and moisturisers. Avoid products with alcohol or dyes.
- Short, cooler baths and showers are better than long hot soaks.
- After washing, pat the skin partly dry. Then apply moisturiser right away on your damp skin.
- Avoid things that make your skin worse. These can include scratchy fabrics, cigarette smoke, strong soaps, detergents and cleaning products.
- Try to prevent scratching. It can lead to infection. Cut your fingernails short. Light cotton gloves can help prevent scratching at night.
Surgical wounds
- Before you leave the hospital or doctor’s office, make sure you know how to care for your wound. Ask where to call if you have questions.
- Always clean your hands before and after caring for your wound.
- Don’t scratch the wound. That can slow the healing. Talk to your health professional if itching is a problem.
- Avoid activities that could cause your wound to pull apart, such as lifting and straining.
- Eat well to heal well. A healthy diet helps wounds heal.
Further information
Antibiotics: Health Navigator
Antibiotic resistance: Health Navigator, Ministry of Health
This report is for you to use when talking with your health professional.
Download this resource
© 2016 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2016), Antibiotics for your skin. When you need them — and when you don’t, developed in co-operation with the American Academy of Dermatology.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.
Ear infection - treatments
A middle ear infection (otitis media) will often get better by itself in a few days as the body’s immune system can take care of the infection without any treatment.
Children with a middle ear infection
Most children older than 2 years won’t need antibiotics to treat a middle ear infection — the infection will clear up by itself in a few days. However, many children younger than 2 years may need antibiotics to treat the infection. Antibiotics won’t help relieve your child’s ear pain. Whilst a child’s ear pain will be of concern to their parents or carers, studies show that 6 out of 10 children will have no ear pain after the first 24 hours without any treatment (antibiotics or pain relief). Pain relief medicines (such as paracetamol or ibuprofen) can help to relieve the symptoms of an ear infection, and will usually only be needed for a short time.
If your child’s symptoms don’t improve after a few days, or their symptoms get worse, see your doctor.
Antibiotics for middle ear infections in children
Antibiotics are recommended for children with middle ear infections who:
- are younger than 6 months
- are younger than 2 years old with an infection in both ears or fluid leaking out of their ear (called ‘otorrhoea’)
- have a fever (a temperature of 38.5°C or higher) and are vomiting.
Babies and infants younger than 6 months old
Infants younger than 6 months old who have ear infections (with or without fever or vomiting) will usually be prescribed an antibiotic. Your doctor will usually ask to see your baby again in 24 hours.
Children aged 6 months to 2 years
Your doctor will advise you on how to relieve the symptoms of a middle ear infection.. Your doctor may ask to see your child after 24 hours, or contact you to ask how they are. If your child’s symptoms don’t improve after 24 hours, your doctor may prescribe antibiotics.
Children aged 2 years or older
Your doctor will advise you on how to relieve the symptoms of a middle ear infection.. If your child’s symptoms don’t improve in 2 days, your doctor will usually examine your child again and may prescribe antibiotics if necessary.
Adults with a middle ear infection
Most adults won’t need antibiotics to treat a middle ear infection — the infection will clear up by itself in a few days.
Your doctor can provide advice about how to relieve your symptoms. If your symptoms don’t improve in 2 days, your doctor will usually examine you again and may prescribe antibiotics.
Paracetamol, ibuprofen or aspirin can help relieve the pain caused by an ear infection.
For more information: Health Navigator.
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 NPS MedicineWise (2016), Medicines and treatments for a middle ear infection. Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.
Bronchitis
What causes bronchitis?
The viruses that cause the common cold or flu (influenza viruses A and B) usually cause bronchitis, but bacteria (e.g. Mycoplasma pneumoniae) can sometimes also cause it.
Other viruses that cause bronchitis include the parainfluenza viruses (which can also cause croup and bronchiolitis), the respiratory syncytial virus (which can also cause bronchiolitis), the coronaviruses (which can also cause colds) and the adenoviruses (which can also cause colds, pneumonia and croup).
The viruses that cause respiratory tract infections such as bronchitis are usually spread when someone infected with the virus sneezes or coughs, releasing droplets that contain the virus into the air. These droplets can be breathed in by others, or transferred to anyone who touches a surface contaminated with droplets containing the virus.
Some people are at more risk of getting bronchitis and of having more severe symptoms including people who:
- are older
- smoke
- have a weakened immune system (e.g. due to HIV or some medicines)
- are exposed to chemicals that can irritate the lung tissue (e.g. in their workplace).
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 NPS MedicineWise (2012), What causes bronchitis?