ירחון החברה הישראלית לפדיאטריה אמבולטורית (חיפ"א) גיליון 2018-2

24 Choosing Wisely Primum non nocere , non-maleficence is the first principle of medicine, often preceding the ethic of beneficence. In light of this ethic, Eric Coon and others investigated whether physicians "overtreat" when caring for their Pediatric patients by recommending diagnostic tests or treatments that may do more harm than good. The results of the investigation are enlightening. Summarized in an article in Pediatrics, they reviewed one year's worth of published articles addressing medical overuse. 143 articles published in 2015 were reviewed and by a process of selection based on quality, magnitude and impact, the 10 most relevant articles were selected and summarized. The thought being, focus on these 10 lessons and we will save a lot of children from much unnecessary intervention. Concurrently, and in the same vein, the American Board of Internal Medicine embarked on the Choosing Wisely Campaign. Similar to Coon's concern with overuse, this initiative focuses on good evidence based medicine, reducing waste and perhaps most importantly, causing no harm. This campaign has been joined by a myriad of medical organizations, including the American Academy of Pediatrics. They present bullet-point recommendations to improve pediatric care. Their recommendations can be found at: www.choosingwisely.org. In the Israel Pediatric Association Conference in 2017, Dr Shimon Barak presented the IPA's position paper encouraging the Israeli Pediatric establishments to learn from the lessons presented by our American colleagues. In this publication, we will dedicate one column to the Choosing Wisely campaign in Israel and in the hope that the IPA will make its own recommendations as needed to address specific practices in Israel. In this issue we will focus on over-radiation and the unnecessary use of CT scans, including 2 recommendations from Choosing Wisely. Choosing Wisely #4: Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure. Choosing Wisely #5: CT scans are not necessary in the routine evaluation of abdominal pain.