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Choosing Wisely

By Dr. Kohar Jones
. 3 Comment(s)

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. 

Share Your Comments

 

  1. Rebecca Jones MD

    Permalink
    Our best bet is to team up with our patients and make sure our decisions are made together! Thanks Kohar.
  2. Scott Poppen

    Permalink
    Love the infographic. I wish more primary care docs followed these recommendations. I wish more patient knew about them. At my annual physical a few months ago, my doc wanted a resting EKG...he believes in yearly EKG for patients with hypertension. I had one last and politely declined another. He wasn't offended. But a ton easier for me to do as a fellow doc and internist than the average patient. Always a bit of mystery to me why smart, well trained docs find it so difficult to change years of habits when good evidence shows those practices to be obsolete.
  3. Anubhav Kaul

    Permalink
    I truly can't believe the the timing of this writing! I actually spent today conversing with Dr. Howard Brody, who championed this initiative, and we talked about the ethical responsibility of physician societies to be transparent about their clinical practice and show leadership in transforming the culture of unnecessary waste.
    glad you brought this up!

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