The Medical Professionalism Blog
The Train Has Left the Station: But Who is On the Train?
I recently attended the Midwest Business Coalition on Healthcare’s (MBCH) Annual Meeting about the Choosing Wisely™ campaign. MBCH is a member of the consumer coalition that will disseminate Consumer Reports’ patient-friendly translations of the 45 recommendations of tests and procedures that physicians and patients should question.
At the meeting, a high-level physician executive of one of the largest health care plans with multiple diversified products addressed an audience of 350 employers who purchase health insurance for their employees. He spoke about information they currently collect on physician quality and cost performance, and described their ability to segment physicians into four quadrants of quality and costs with high quality and low cost being the sweet spot. This kind of segmentation would enable their subscribers to select the best physicians and hospitals. Claims data could provide that and more. Health plans claim they can compile such meaningful data from multiple sources – both inpatient and outpatient care – and integrate those data sources to provide a total picture of health care received.
Recommended Reading: May 4-11
For this week’s Recommended Reading, check out several articles on stewardship of resources, including its role in organizational professionalism:
- In “From an Ethics of Rationing to an Ethics of Waste Avoidance,” Howard Brody argues for a stepwise strategy to eliminate unnecessary care given the limitations of comparative-effectiveness research, saying, “it is better first to eliminate interventions for which we have the most solid and indisputable evidence of a lack of benefit.”
- M. Gregg Bloche urges policymakers to move beyond the elimination of unnecessary care, stating that “eliminating only ineffective care would shift the cost curve down but wouldn’t change its slope.”
- A new Academic Medicine article identifies fairness as a guiding principle for professional behavior, and suggests organizational professionalism includes the ethical stewardship of resources.
The Testing Glut
This post originally appeared in the L.A. Times.
In case you missed it, a recommendation came out last month that physicians cut back on using 45 common tests and treatments. In addition, patients were advised to question doctors who recommend such things as antibiotics for mild sinusitis, CT scans for an uncomplicated headache or a repeat colonoscopy within 10 years of a normal exam.
Recommended Reading: April 28-May 4
For this week’s Recommended Reading, check out more coverage of Choosing Wisely® and other articles on overuse:
- Brad Flansbaum asks whether we are “Choosing Wisely or Vicely” on the Hospitalist Leader blog.
- The Wall Street Journal calls Choosing Wisely “Care That’s Just Right”
- American Cancer Society Medical Director Otis Brawley delivered a speech at a recent Association of Health Care Journalists meeting in Atlanta, in which he argued that we are all responsible for overuse.
Random Acts of Medical Professionalism
I have been mulling over the concept of recognizing random acts of professionalism for years – honest! I cannot believe that lawyers from the Washington State Bar Association beat me to it.
“Professionalism may not be sufficient to drive the profound and far-reaching changes needed in the U.S. health care system, but without it, the health care enterprise is lost.”
All We Are Saying Is… Give Professionalism A Chance
As ABIM and ABIM Foundation President and CEO Chris Cassel pointed out in her recent post, the Choosing Wisely® campaign is medical professionalism in action. But this is not professionalism where protectionism is being professed. Rather, the profession has taken the bold and brave step of not only identifying the tests with little value but welcoming a partnership with Consumer Reports and other consumer and employer groups. Physicians are taking the lead, and patients and all stakeholders appear to welcome this change.
Recommended Reading: April 19-27
This week’s Recommended Reading focuses on new recommendations with the potential to improve stewardship of health care resources:
- The Commonwealth Fund Commission on a High Performance Health System issued a proposed strategic plan for community-based approaches to improving care and lowering cost for individuals with chronic illnesses. They estimate that creating 50 to 100 voluntary “Health Improvement Communities” could result in $184 billion in health care savings over a ten-year period.
- The Patient-Centered Outcomes Research Institute outlined its vision for patient-centered comparative effectiveness research in a new issue of JAMA.
A Key to Success for Choosing Wisely – R.E.S.P.E.C.T
In my post, Fresh Air in the Capital and Throughout the Nation, I wrote about the important ingredients for initial success of the Choosing Wisely® campaign:
- Right messenger
- Right message
- Simple actionable steps
- Respectful and trusting relationships
In this post, I want to address the last, fourth pillar for the campaign: Respectful and trusting relationships. It is these relationships that will ultimately determine the success of the Choosing Wisely campaign. These respectful relationships are not just patient/provider, but physician/physician, society/member, government/stakeholder and beyond.
Recommended Reading: April 12-19
The blogosphere continues to buzz about Choosing Wisely®. Below is a sampling of recent posts:
- Forbes notes that Choosing Wisely “has dominated health headlines since nine medical specialty boards recently announced their support…”
- David Katz, Director of the Yale Prevention Research Center, calls Choosing Wisely Good Answers for Good Questions.
- Michael Barry of the Informed Medical Decisions Foundation developed a brief video giving an overview of the campaign and key takeaways.
- Robert Centor of db’s Medical Rants rebuts pushback against the campaign.
Joining the Choosing Wisely Campaign
The Choosing Wisely® campaign’s focus is on developing conversations between patients and physicians and among physicians about appropriate care and smart decisions. The catalyst for these conversations and decisions are the “Five Things” lists of tests and procedures where there is little or no evidence on their effectiveness in diagnosing or treating an illness. Through this campaign, we hope physicians will begin to think about evidence, and ask themselves how a certain test or procedure will help them make a diagnosis and/or how it would alter a treatment plan. Physicians I’ve spoken to also tell me the campaign is about acknowledging and managing the fact that no physician can ultimately be 100% certain about knowing what is going to make a difference to the patient’s health.
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