13 outdated clinical habits docs want to retire
Industry Buzz
C collars on every major trauma. In ten years I hope we look at collars like we currently look at hard backboards. They are tools with use in some specific situations, but are actively harmful when used as a blanket mandatory treatment.
—@Chcknndlsndwch
In a sprawling Reddit thread in r/medicine that quickly drew tons of comments, physicians from nearly every specialty—cardiology, neurology, OB/GYN, radiology, psychiatry, and more—answered a deceptively simple question: What are some things we still do in medicine for no good reason?
From reflexive daily labs to outdated trauma practices, the thread reads like a crowdsourced audit of low-value care—written not by critics, but by the clinicians ordering it.
Oncology/hematology
Here’s a definitive list from hematologist @CatShot1948:
“Thrombophilia testing in low probability patients. And basically never should be done inpatient. (Ortho asked me to expedite factor V lieden testing that wasn't indicated recently.)”
“Failure to take a menstrual history on every menstruating patient (should be treated as a vital sign). Failure to take a COMPETENT menstrual history. And then failure to recognize what's abnormal menstruation and work it up at all.”
“Sending a patient for thrombophilia evaluation due to "family history of blood clots" but the clots are in a 3rd degree relative.”
“Correcting INR in liver patients prior to procedures (INR is not predictive of bleeding risk due to rebalanced hemostasis and loss of natural anticoagulants).”
“Monitoring Direct Thrombin Inhibitors with PTT in a patient who has abnormal baseline PTT.”
Cardiology
Reddit user @schlingfo, who works in a hospital, said, “Trendelenburg for hypotension. Every time I walk into a room with some peepaw in Trendelenburg, I just quietly put the bed back into a neutral position. 15 years of knowing it doesn't do anything significant, and we keep on doing it.”
Neurology
Echo tech @Ayriam23 said, “I hope that in my career the bubble study TIA/CVA patients that would never be considered for a closure device becomes a thing of the past. It is just asinine to be doing this for 80+ year olds with diffuse risk factors. I've only seen 3 cases of a PFO very likely causing a CVA. 2 were pediatrics with an underlying clotting disorder and another had a large PE and immediate CVA. I'm sorry, but meemaw who is 97 just doesn't need a bubble study, so please stop.”
Rheumatology
Rheumatologist @blizz_fun_police said, “Ordering rheumatology labs because you don’t know what’s going on. Then sending me the patient because you got unexpected results and don’t know what to do with them. But please keep doing this and sending me the patients.”
Psychiatry
Emergency medicine physician @Yeti_MD said, “All sorts of mandatory labs (and even imaging!) for ‘medical clearance’ of psychiatric patients. Pretty much all the big psych and EM societies have guidelines on this, but I still get demands for all sorts of nonsense workup. Medical testing should be done as indicated based on history and clinical presentation, and mandating big workups for medically stable patients is a huge waste of time and money. I promise the healthy 25yo with chronic depression did not take a handful of fluoxetine because they're suddenly hyponatremic.”
Another emergency medicine physician, @potaaatooooooo, said, “Not offering buprenorphine or methadone plus Narcan for patients with opioid use disorder!!!!!”
Related: Docs divulge the most alarming 'catastrophic misses' from their careerOB/GYN
Reddit user @FlexorCarpiUlnaris, who works in the NICU, said, “NICU babies having to pass a ‘car seat test’ before going home. We sit them in a car seat and watch their [stats] for a couple hours. No evidence to support it. But it costs nothing and is usually done overnight so doesn’t disrupt the day. It will never change.”
Radiology
Radiologist @ddroukas said, “You don’t have to order abdomen and pelvis for everything. If there’s buttock hematoma you can just order pelvis. If you have a question of pancreatic ductal dilatation you can just order abdomen.”
Emergency medicine
Reddit user @Chcknndlsndwch, who works in emergency medicine, said, “C collars on every major trauma. In ten years I hope we look at collars like we currently look at hard backboards. They are tools with use in some specific situations, but are actively harmful when used as a blanket mandatory treatment.”