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Walk the evidence base by book and chapter — the raw source passages that ground Ask, Differential, and the rest.
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Don't obtain screening resting or exercise electrocardiograms in asymptomatic adults at low risk for coronary heart disease. Setting: asymptomatic adult at low risk for coronary heart disease undergoing routine health assessment Why: Screening ECGs in low-risk asymptomatic adults rarely change management and lead to false positives and a cascade of further testing. Consider instead: cardiovascular risk-factor assessment instead of screening ECG Source: American College of Physicians (Choosing Wisely, US, 2012).
Don't obtain MRI for chronic or recurrent low back pain without red flags and without documented failed conservative care. Setting: chronic or recurrent low back pain (more than 6 weeks, or relapsing over months to years) with no red flags (radiculopathy or neurological deficit, major trauma, history of cancer, unexplained weight loss, fever/infection, immunosuppression) and no documented trial of failed conservative care Why: MRI in chronic low back pain without red flags correlates poorly with symptoms, rarely changes management, and triggers incidental-finding cascades and unnecessary intervention. Consider instead: structured conservative management (activity, analgesia, physiotherapy) with reassessment; image if red flags emerge or a specific intervention is planned Source: American College of Physicians (Choosing Wisely, US, 2012).
Don't obtain MRI for chronic or recurrent low back pain without red flags and without documented failed conservative care. Setting: chronic or recurrent low back pain (more than 6 weeks, or relapsing over months to years) with no red flags (radiculopathy or neurological deficit, major trauma, history of cancer, unexplained weight loss, fever/infection, immunosuppression) and no documented trial of failed conservative care Why: MRI in chronic low back pain without red flags correlates poorly with symptoms, rarely changes management, and triggers incidental-finding cascades and unnecessary intervention. Consider instead: structured conservative management (activity, analgesia, physiotherapy) with reassessment; image if red flags emerge or a specific intervention is planned Source: American College of Physicians (Choosing Wisely, US, 2011).