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Choosing Wisely

We live in a land of choice.  We get to choose our breakfast cereals.  We get to choose our presidential candidates.  And as doctors, we get to choose the tests we order for our patients.

Choose wisely.  This campaign sponsored by the American Board of Internal Medicine Foundation, in partnership with nine specialty societies, urges doctors to choose the tests that make a life or death difference (or at least improve patient well being), and stop habitually ordering tests that don’t improve patient outcomes or save lives. Each specialty got to choose five overused tests or treatments to say to physicians: don’t choose these.

5 of the 45 tests and treatments the specialty societies have advised not to order without specific indication:

Annual electrocardiograms or other cardiac imaging in low risk patients without symptoms.

Antibiotics for mild-to-moderate sinusitis unless symptoms last for seven or more days or worsen after clinical improvement

Imaging for low back pain within the first six weeks, unless red flags are present.

Imaging for uncomplicated headache.

Preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology. 

These recommendations don’t say don’t choose these tests, period.  They say choose these tests wisely.

A new report from the Institute of Medicine, Best Care at Lower Cost, examines how we can improve US health care while saving money.  The measures it promotes:  use information technology more effectively, create systems to manage complexity, make healthcare safer, improve transparency, promote teamwork and cooperation, and partner with patients.  It’s final recommendation: decrease waste and increase efficiency, to save an estimated $750 billion each year. For a powerful visual summary of the report, check out this simple infographic. 

More is not better, when it comes to health care.  The $750 billion saved by judicious ordering on the part of physicians is 1/3 the total cost of our crippling health care budget.

As a doctor, what changes will you make in your practice?

As a patient, what changes will you make in your expectations for care?

Together, we can choose a cost-effective healthcare system.