1. 1

    Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination

  2. 2

    Do not request X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology 

  3. 3

    Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle

  4. 4

    Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties   

  5. 5

    Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated


​How this list was developed

Lead Fellows from AFOEM worked with the RACP to compile a list of 9 recommendations regarding low-value clinical practices in occupational and environmental medicine; using as a basis the 2014 Choosing Wisely recommendations from the American College of Occupational and Environmental Medicine and the Occupational Medicine Specialists of Canada.

An online survey on these 9 initial recommendations was sent to AFOEM members asking for feedback on the evidence behind the recommendations, their relevance to OEM in Australasia, and whether or not their experience and expert knowledge supported their inclusion in AFOEM’s ‘top 5’ list. Respondents were also asked to nominate any other relevant items not already covered.

Based on survey responses, each of the nine recommendations was assigned a score and ranked accordingly. The feedback on the initial proposed items was reviewed and considered, alongside additional suggested practices. Based on this and a further review of evidence, these top-5 recommendations were approved by the AFOEM President.

A number of other specialties and stakeholders which have clinical practices or expertise of relevance to this list and health consumer groups in both Australia and New Zealand were invited to provide feedback on the proposed final list and the specific recommendations