IMSANZ has partnered with RACP EVOLVE and NPS Choosing Wisely in developing a list of 5 recommendations concerning clinical practices which are  of low value and should be avoided whenever possible. These have been developed using a transparent and rigorous methodology that has involved input from representative samples of general physicians. IMSANZ Council and Board would urge you to familiarise yourselves with these recommendations and implement them in your communities of clinical practice.  More recommendations will be forthcoming and we welcome your comments and suggestions on both current and future lists. We would also be keen to hear of quality improvement projects that members are considering or undertaking in regards to implementation and evaluation of listed recommendations.

A panel of IMSANZ members produced an initial list of 32 low value tests, treatments and management decisions frequently encountered in general medicine services. 350 members of a working group comprising approximately 50 general physicians as well as nurses and allied health professionals were asked to rank the items in terms of priority and nominate additional items. Based on their responses, the list was condensed to 15 items including three which were not previously listed. Following further discussion, this was reduced to a list of 10.

Recommendations on ‘what not to do’ were formulated around these 10 items and a summary of the evidence for each recommendation was prepared. An online survey was sent to all IMSANZ members asking respondents to assign a score from one to five for each recommendation on three criteria (evidence, frequency, and patient harm and cost). The survey attracted 182 respondents from all across Australia and New Zealand, which was a response rate of 26 per cent. The five with the highest average total scores were confirmed as the final list.
The full list of IMSANZ recommendations can be accessed on the EVOLVE website.
To download a copy, please click here.



EVOLVE is a physician-led initiative to ensure the highest quality patient care through the identification and reduction of low-value practices and interventions.

EVOLVE is patient-centred and evidence-based, with rigorous and transparent processes. Its focus is to stimulate clinical conversations – between colleagues, across specialties, and with patients – to ensure the care that’s delivered is the best for each patient.

EVOLVE is part of a worldwide movement to analyse medical practices and reduce unnecessary interventions. It is an initiative in partnership between the RACP and the Specialty Societies, Divisions, Faculties and Chapters.