Choosing Wisely, Breaking a Mold

For many people, going to the doctor comes with the expectation of getting a test done and a medication prescribed. But study after study show that more care does not mean better care. And too much care is having a real impact on our healthcare system and our wellbeing.

The Institute of Medicine estimates that one third of our healthcare expenditures – around $750 billion – don’t improve health. As anyone who has ever had a test done knows, they aren’t cheap. For years, doctors have overused medical tests, performed unnecessary procedures, and prescribed unneeded medications.

So why do they do it? According to a physician survey published in the Archives of Internal Medicine (now JAMA Internal Medicine) in 2011, 42 percent of primary care physicians believe that patients receive too much care. The most common reasons cited for over-testing were fear of malpractice suits, clinical performance measures, and, interestingly, as a substitute for not being able to spend more time with the patient. Perhaps most concerning is the recognition that diagnostic testing would be reduced if it didn’t bring in revenue, especially for medical subspecialists.

Last week I began noticing posts on social media sites urging patients to ask more questions of their doctors. I eventually clicked my way to a page full of lists for patients and healthcare providers, explaining when a medical test or procedure is necessary and when it should be passed over.

What I’d found was a push for the Choosing Wisely campaign, an initiative from the ABIM Foundation that promotes conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

bestcare_infographicOrganizations representing more than 500,000 physicians, such as the American Academy of Pediatrics, the Society for Vascular Medicine, and the American Geriatrics Society, came up with their own lists of tests and procedures that should be questioned or discussed. The website also includes patient-friendly resources from specialty societies and Consumer Reports advising patients on the right and wrong situations for certain tests or procedures.

The key word here is “choose.” The novel idea of patient empowerment is growing in popularity as we begin turning to the Internet for health information. According to Pew’s 2013 Health Online Report, 59 percent of American adults have looked online for health information in the past year, and 35 percent have looked online specifically to try to diagnose a medical condition they or someone else might have.

I’ll be the first to admit I have an addiction to WebMD. But a Google search can’t always replace a doctor’s visit. Despite the rise in online health seeking behavior, the reality is that when we actually step into a doctor’s office, we often clam up. Patients are often too afraid or embarrassed to reveal all of their health issues to their doctor and often don’t ask questions during their visits.

Doctors are one of the most trusted groups in the US — behind the military and nurses — so when a physician tells us we need a test, we’re unlikely to argue. We’ve been brought up to believe that doctors have our best interests at heart, and not to question a doctor’s orders. While a physician obviously knows more than I do about medicine, treatment and care, that’s not to say that I shouldn’t own my health and be an informed patient. The Choosing Wisely campaign marks a shift towards patient education — while a doctor may be to blame for ordering too many tests to get paid, we often share that blame. Parents demand antibiotics for their kids’ colds, and many demand tests like CT scans for headaches when they aren’t the doctor’s first choice.

These practices can physically harm patients by exposing them to more medical errors and adverse events from medications, alter their quality of life, and they contribute to the country’s outrageous levels of healthcare spending.

Some of the recommendations you find in the lists seem extreme, or counterintuitive – like no Pap tests for women under 21. And as someone who suffered from frequent sinus infections as a youngster, learning that antibiotics may not have always been the right way to go was jarring. But that’s part of the problem. We become resistant to changes in guidance, especially when we learn that something so common for so  long may not have been the best idea.

This initiative really is an example of partnership, and patient care, at their greatest. Efforts like this can have an impact on the national level, by reducing costs associated with healthcare, and on the individual level, by expanding patient education and improving health. And it’s all presented in a neat, user-friendly website.

As someone who is always thinking about health – for my work, for myself and for my family – these lists are a huge resource. I just hope that others find the same value in them, instead of leaning on tradition and conspiracy theories the way Americans are inclined to do lately.


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