On October 3, 2018, the Canadian Society of Internal Medicine announced the release of five new recommendations of tests, treatments or procedures to question. These five new recommendations are in addition to the previously released internal medicine list. The five new recommendations include:

• Don’t do a workup for clotting disorders (hypercoagulability testing) for patients who develop first episode of DVT in the setting of a known precipitant.
• Don’t undertake prolonged life-sustaining treatments or escalate to intensive care without establishing prognosis, preferences and goals of care.
• Don’t order or refer for percutaneous coronary intervention in patients with stable coronary artery disease that do not have high risk features, and are asymptomatic or have not been on optimal medical therapy.
• Don’t order continuous telemetry monitoring outside of ICU without using a protocol that governs discontinuation.
• Don’t initiate long-term maintenance treatments (e.g. bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, or other) in adult patients with suspected COPD/asthma without confirming a diagnosis with objective testing such as spirometry/methacholine challenge.

See Eleven Things Physicians and Patients Should Question in Internal Medicine to view the full list, including a rationale and references for each recommendation.

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