Become a Myth Buster: Use Evidence-Based Medicine to Change Clinical Care

When was the last time you took a step back and questioned your medical decision making? Why did you decide to prescribe that treatment at that dosage and for that exact duration? Was that test truly necessary to establish a diagnosis or alter management? Is your decision based upon what you were taught during residency or something you learned from your peers? If you took the time to investigate the evidence (or lack thereof) regarding what we consider to be “standard of care,” the information you find may surprise you.

As an allergist, I treat many common pediatric conditions including asthma, allergic rhinitis, food allergies, and atopic dermatitis. I became interested in researching the origins of medical myths after encountering the same misinformed questions or outdated information from patients as well as referring physicians. According to the Pew Research Center, 72% of internet users look online for health information.

I encourage you to spend a few minutes searching the same information as our patients — you will quickly appreciate the vast amounts of misinformation encountered through internet searches, social media networks, and in some cases, sites looking to profit by offering “magic cures.”

It took additional research to better understand why physicians, including those who are well trained and highly regarded by their peers, were ordering unnecessary and potentially harmful diagnostic tests or providing incorrect recommendations to their patients. As physicians, we all strive to provide the best possible care for our patients and took an oath to “do no harm.” However, it is virtually impossible for any physician to stay on top of all the latest and greatest evidence, regardless of desire and good intentions. Many previously held beliefs have since been refuted, whereas others were not based on sound evidence. Published guidelines reflect high quality evidence or consensus expert opinion. However, it can take years before guidelines are implemented into practice by busy clinicians.

To help equip physicians with up-to-date, evidence-based information that enables them to make well informed decisions, the American Board of Internal Medicine has partnered with over 60 subspecialties to create the Choosing Wisely^® series. These open access lists address common misconceptions across almost all areas of specialty care and can be very useful for both patients and physicians.

Within allergy and immunology, there are common myths that lead to unnecessary testing, improper diagnoses and increased health care costs. For some of these, new evidence has emerged that dramatically changes prior recommendations. For others, they were never truly based upon evidence but yet have permeated medical practice.

A few examples from the Allergy and Immunology Choosing Wisely^® series:

• Don’t perform food IgE testing without a history consistent with potential IgE-mediated food allergy.
• Don’t rely on antihistamines as first-line treatment in severe allergic reactions.
• Don’t routinely avoid influenza vaccination in egg-allergic patients.
• Don’t overuse non-beta lactam antibiotics in patients with a history of penicillin allergy without an appropriate evaluation.
• Don’t diagnose or manage asthma without spirometry.

A thorough review of these recommendations lies outside the scope of this post, but I encourage you to visit these lists for additional details, including references.

Next time you consider ordering a diagnostic test or prescribing a specific treatment, ask yourself: Why do I do it this way? Is this supported by evidence, or is it something that has been passed down through training and adopted into clinical practice? Spend a few minutes researching the evidence — I bet you’ll be surprised.

References:

1. Pew Research Center: Health Fact Sheet. http://www.pewinternet.org/fact-sheets/health-fact-sheet/. Accessed September 10, 2015.
2. Choosing Wisely.^® http://www.choosingwisely.org. Accessed September 10, 2015.
3. American Academy of Allergy, Asthma & Immunology: Ten Things Physicians and Patients Should Question. http://www.choosingwisely.org/societies/american-academy-of-allergy-asthma-immunology. Accessed September 10, 2015.