The French Society of Internal Medicine’s Top-5 List of Recommendations: a National Web-Based Survey

Abstract

Background: The international project “Choosing Wisely” aims to target unnecessary and potentially harmful examinations and treatments. Objective: To define the French Internal Medicine Top-5 list. Design: Based on a review of existing Top-5 lists and personal experience, a working group of the French National Society of Internal Medicine selected 27 diagnostic and therapeutic procedures. They were submitted through a national web-based survey to French internists who rated from 1 to 5 the perceived frequency, uselessness, and risk of each procedure. A composite score was calculated as the unweighted addition of the three scores. Participants: Four hundred thirty internists answered the web-based survey (14% of all French internists including residents). All the French regions and status of the profession were represented. Key Results: For the 27 submitted procedures, the mean score (± SD) was 3.25 (± 0.48) for frequency, 3.10 (± 0.43) for uselessness, and 2.63 (± 0.84) for risk. The Top-5 list obtained with the composite score was as follows:1.Do not prescribe long-term treatment with proton pump inhibitors without regular reevaluation of the indication2.Do not administer preventive treatments (e.g., for dyslipidemia, hypertension…) in elderly people with dementia when potential risks outweigh the benefits3.Do not administer hypnotic medications as first-line treatment for insomnia4.Do not treat with an anticoagulant for more than 3 months a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor5.Do not screen for Lyme disease without an exposure history or related clinical examination findings We found that the composite score was strongly correlated to the risk score (rs = 0.88, p < 10−5) and not to the frequency (rs = 0.06, p = 0.75) or uselessness score (rs = 0.17, p = 0.38). Conclusions: This Top-5 list provides an opportunity to discuss appropriate use of health care practices in internal medicine.