Patient conversations can be tough. There’s no way around it. Sometimes, it’s hard to communicate to a patient—or the patient’s family—that a particular procedure or treatment option may be unnecessary. But as physicians, it’s up to us to start that conversation to ensure our patients are receiving only the right care at the right time.
Over the past few weeks, I’ve been thinking a lot about overuse of certain tests and procedures and the need for more effective use of health care resources. At the AMA’s State Legislative Strategy Conference earlier this month in Tucson, Ariz., a panel about health care quality really caught my attention. It was called “Confronting health care costs: Playing offense is the best defense.”
One of the panelists was John Gordon Harold, MD, a member of the American Board of Internal Medicine (ABIM) Foundation board of trustees, who spoke about an initiative you may have heard of: Choosing Wisely®. This ABIM Foundation initiative promotes physician-patient conversations about getting care that is specific, evidence-based and truly necessary.
More than 60 national medical specialty societies, representative of more than 500,000 physicians, have each identified five commonly used tests or procedures in their fields that should be questioned or discussed. This physician-driven initiative helps us to protect patients against unnecessary care, empowers us to be stewards of finite resources and guides us in how to communicate these things to our patients.
Dr. Harold’s remarks resonated with me. He explained that this initiative represents a new paradigm shift in the conversation about cost and appropriateness. It’s about making sure that safety, quality and stewardship align and patients understand why certain tests or procedures may not be good for them. More than 300 recommendations have been produced so far—a pretty hefty load in the two years since Choosing Wisely began.
Dr. Harold’s practice has embedded 120 of the initiative’s recommendations into its electronic health record (EHR) system. During appointments, physicians see appropriate reminders about medical care they should question before ordering. If a physician decides to override the recommendation, he or she must enter an explanation to articulate why that care is necessary.
Most of the current recommendations are “low-hanging fruit,” as Dr. Harold put it. While they are things we all know, te initiative presents the information in a new way—the beginning of a conversation between physicians and patients.
I highly recommend that you take advantage of what this initiative has produced. It’s intuitive, logical and empowering. Most importantly, it can help us eliminate unnecessary tests and procedures that contribute to spiraling health care costs and make sure our patients are receiving only the care that’s best for them.
