This Month's News
Teaching wisely: Ensuring tomorrow's doctors give high-value health care
Teaching students and residents about stewardship of health care resources is a key concern facing academic medicine and health care as a whole.
This pressing need is underscored by the continuing increase in health care spending, which is projected to reach 20 percent of the nation's gross domestic product by 2015. Further, data from the Institute of Medicine show that $210 billion is spent annually on "unnecessary services," which increase costs without benefiting patients.
At its recent meeting in Philadelphia, the AMA Section on Medical Schools (SMS) examined how medical schools can ensure that physicians-in-training learn how to practice high-value, cost-conscious care and avoid overuse and misuse of resources.
Steven E. Weinberger, MD, FACP, executive vice president and chief executive officer of the American College of Physicians, was keynote speaker for the meeting, along with Jacqueline A. Bello, MD, FACR, professor of clinical radiology and neurosurgery at Montefiore Medical Center and Albert Einstein College of Medicine.
Dr. Weinberger discussed the Choosing Wisely initiative and the importance of teaching students/residents about high-value care. He also discussed ways in which to engage and develop faculty in this domain.
In his talk, Dr. Weinberger cited a 2010 study finding that nearly two in three residents reported having no idea about the cost of tests. "That is ridiculous—it's probably really 98 percent or 99 percent," he said. "Virtually no one has an idea of the costs of the tests that we do."
One solution: Medicine must "get rid of the long-hanging fruit" by looking closely at interventions that provide no benefit and/or may be harmful. "We should not be doing these at all—independent of the cost," Dr. Weinberger noted. "Whether it's $100,000 or $100, if it's not indicated, it should not be done."
Next, Dr. Bello began her presentation by describing "responsibility" as the new "R word" in medicine, in place of "rationing." She noted that medical education curricula are silent on the issue of cost in diagnosis and treatment, for a number of historical, philosophical, structural, and cultural reasons. Quoting a 1975 editorial, however, she said that physicians have the professional obligation to be "good stewards of the medical commons."
It was also noted that the real issue in the training environment (and medicine itself) is acceptance of uncertainty, and overcoming the sense of discomfort with not necessarily knowing the diagnosis. Often, physicians should simply "give a little of tincture of time" to the patient and see what happens.
Two members of a reactor panel responded to the presentations: Bonnie M. Miller, MD, senior associate dean for health sciences education at Vanderbilt University School of Medicine, and Maryellen E. Gusic, MD, executive associate dean for educational affairs at Indiana University School of Medicine. Both institutions are among the 11 grant awardees in the AMA's Accelerating Change in Medical Education initiative.
In addition, Arthur M. Feldman, MD, executive dean and chief academic officer, Temple University School of Medicine, opened the meeting with a look at the many challenges (and opportunities) in academic medicine and health care. He also touched on the need for residency program funding to align with the needs of society.