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COST EFFECTIVENESS/YIELD/MEDICAL ECONOMICS
Which Patients of Backache Need X-rays or Imaging?
OP Kapo
90-95% of the patients with backache have underlying mechanical causes and do not need any investigations. But the family physicians should be careful in the following patients, where X-ray (and further imaging if required) is necessary.
1. Patients, who are less than 16 years old or more than 50 years old.
2. Patients, who complain of morning stiffness associated with pain locally, and this pain improves with exercise and walking.
3. Patients having continuous pain.
4. Patients having history of accident or injury.
5. Patients, who complain of fever or weight loss.
6. Patients having anaemia or low haemoglobin (specially males).
7. Patients having an elevated ESR.
Unless the above principle is followed in practice, it is impossible to decide whether the patient should be sent for an X-ray or imaging.
BREASTS AND ALLERGIES
The protection against allergies and asthma afforded by breastfeeding has been hotly debated. There are many valid reasons for encouraging breastfeeding during the first 4-6 months of life, but that the prevention of asthma and allergies is not one of them.
Lancet, 2002; 3 : 887, 901.
(Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.)
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