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Overuse of antibiotics represents a serious challenge facing the health care system. This week, a number of well-known organizations, inspired by the aims of the Choosing Wisely® campaign, came together to focus their efforts on this issue.
I couldn’t be more pleased that the Choosing Wisely campaign is finding its way across international borders. Choosing Wisely Canada will be operational this fall under the umbrella of the Canadian Medical Association and guided by the University of Toronto. At least eight Canadian specialty societies will release lists of five tests and procedures to question and others are expected to follow. The Netherlands, Germany, United Kingdom, Denmark, Italy, New Zealand, Australia and Israel have all expressed interest in implementing the campaign. While the ABIM Foundation has not deliberately tried to advance Choosing Wisely to other countries, we are nonetheless supportive of these efforts and have provided guidance as they move forward with their own initiatives.
The Choosing Wisely campaign was recently criticized for lacking a solid methodological approach in an editorial in JAMA Internal Medicine by Deborah Grady, Rita Redberg and William Mallon. As such, we wanted to clarify the procedures that all of our specialty society partners have followed in creating their recommendations of tests and treatments that physicians and patients should question.
This post was written by Dr. John Benson, Jr., President Emeritus, American Board of Internal Medicine and ABIM Foundation.
The prospect of health care consuming 20% of the GDP by 2020 is unconscionable so corrective actions have enormous urgency. There are some initiatives underway that address this issue and still others that need to happen in order to bring stewardship to the forefront of individual physicians and organizations at-large.
Through its admirable Choosing Wisely® campaign, the ABIM Foundation has promulgated the concept of stewardship of limited resources—especially unnecessary, even harmful, costs—as a clinical competence to be stressed to trainees. None too soon, especially since only 36% of physicians polled in 2013 feel they are responsible for rising costs or their reduction. Obvious proof that there is so much more ground to cover in this area.
As a start:
- Some teaching hospital administrators, who see Graduate Medical Education’s acolytes as a risk to their current modus operandi, must stop acting as competitors in a local technology arms race: pricing services without relationship to costs, skimping on nurse/inpatient ratios, counting outpatient clinics as losers and regarding premature readmissions as revenue.
- ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC.
- ACP could grade use of resources through MKSAP questions.
- CMS, which has the ultimate negotiating position in the form of reimbursement for Medicare services, could only accept negotiated bundled charges. It could also refuse payment for non-compliance with the Choosing Wisely recommendations.
- Educators, if forced to adhere to stricter ACGME’s accreditation standards, can reward suitable ordering behavior by trainees or require meaningful interventions.
The time is well past exhortation. The issue has been recognized for decades. Hard choices and penalties must go beyond training the next generation. 2020 is closing in.
Some people feel dread as the work week looms. Others find it hard to engage in their daily tasks. Everyone suffers from work stress from time to time, but ongoing stress can erode well-being and lead to burnout. With physician burnout, there can be severe consequences for both physician well-being and patient care. Health care organizations also suffer as physicians leave their institutions—or in some cases, leave the profession altogether.
As part of my Master of Public Health degree, I completed my master’s thesis at an HIV/AIDS clinic in Philadelphia where I evaluated a program that helped patients adhere to their antiretroviral medications. A key part of this program was the clinic’s pharmacist, who provided ongoing medication counseling. It was the first time that I really saw a pharmacist integrated into health care delivery and I greatly appreciated the insights and support she provided to patients. I also wondered why pharmacists aren’t more commonly seen as part of a patient’s health care team.
I thought the authors of the recent New England Journal of Medicine article, “Choosing Wisely — The Politics and Economics of Labeling Low-Value Services” presented the campaign in a thoughtful and balanced manner. On one hand, I was pleased with how the campaign was depicted—particularly the authors’ praise for the way it carefully created a space for physicians and patients to have conversations. This has been our vision since the very beginning.
This post was written by Giffin Daughtridge, a medical student at the University of Pennsylvania and a winner of the 2013 Teaching Value and Choosing Wisely Competition.
The timing of the e-mail I received announcing the Teaching Value Choosing Wisely competition could not have been better. One week earlier, I had met with Dr. Richard Shannon, then the Chair of Medicine at Penn and now the Executive Vice President of Health Affairs at the University of Virginia, to discuss a common interest we shared in generating high-value health care. We agreed that physician decision-making represented a powerful lever to improve value, and that decision-making skills were most malleable early in a clinician’s training. As such, we decided to develop a course for medical students to bring awareness to the impact of physician decision-making on both costs and quality of care.
The Super Bowl is upon is, and on Sunday much of the country will be busy watching the big game, eating 1.25 billion chicken wings, and of course critiquing the halftime show and commercials.
While the Super Bowl is a great deal of fun, serious injuries can also occur. With that in mind, I wanted to revisit my recent post on medical professionalism in sports medicine. Physicians working with professional sports teams may face conflicts between ensuring a player’s mental and physical well-being and the needs of the team.
This post was written by Cheryl O’Malley, MD, FACP, Program Director, Internal Medicine and Steven R. Brown, MD, FAAFP, Program Director, Family Medicine at Banner Good Samaritan Medical Center, University of Arizona College of Medicine – Phoenix. Drs. O’Malley and Brown were winners of the 2013 Teaching Value and Choosing Wisely Competition.
A little friendly competition is a good thing. We’ve seen it work in our residency programs. That’s why we answered the challenge of the “Teaching Value and Choosing Wisely Competition” with a competition of our own.