The Medical Professionalism Blog
Recommended Reading – January 23-27, 2012
ABIM Foundation staff tracks news stories, blog posts and journal articles related to professionalism, with a specific focus on physicians’ stewardship of resources. Recently, there has been a sharp increase in the number of stories, posts and articles on stewardship. Our new Recommended Reading posts will help keep you informed of the latest news in this area.
Extremist Proposal Shocks the Medical Establishment
I suspect many were shocked, even disturbed, upon reading the article, Professionalism, the Invisible Hand, and a Necessary Reconfiguration of Medical Education by distinguished professor of medical education at Mayo Clinic, Fred Hafferty, and his two colleagues, Drs. Brennan and Pawlina. In the article, the authors call for all medical students to achieve competency in the economics of care prior to seeing their first patients. They state:
“There will be no traditional ‘patient care’ contact until students are fully able to decode and explain the highly cryptic billing statements that encumber patients. As students enter the bio-medical side of their training, patient meetings will begin to add explanations of diagnosis and treatment options to those of cost.”
Trying to Make Professionalism Real And Parsimonious
There has been a lot of both positive and negative reaction by physicians and others to the recently released American College of Physicians (ACP) Ethics Manual that states:
“Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.”
Some have reacted to the notion of “parsimonious care” as it relates to cost effectiveness. Others have reacted to the idea of equitable availability of resources. The latter concept refers to a societal obligation to treat patients within a just system. ACP’s Manual describes the need to provide services to the uninsured and underinsured and not to deny care based on the inability to pay.
Putting the Charter into Practice Grantee: American College of Physicians Center for Ethics and Professionalism
This is the final entry in a series of posts written by the ABIM Foundation’s Putting the Charter into Practice grantees, which describes their motivation to pursue projects related to stewardship of resources.
The ACP Ethics, Professionalism and Human Rights Committee recently completed the sixth edition of the ACP Ethics Manual, published in the Annals of Internal Medicine on January 3, 2012. During its development, I was struck by how the more things change, the more they stay the same. Certainly, many topics are new, like:
- Online professionalism and the use of social media by physicians
- Confidentiality and electronic health records
- Health system catastrophes
But the principles that guide us are not. The challenge lies in applying them to emerging concerns, dealing with change and reaffirming what is fundamental. The stewardship of health care resources is a major concern and is commented on throughout the Manual.
Healthy as a Horse No More: My Recent Patient Experience
I knew that I would come to rue the day I wrote my post on my EKG claiming I was a healthy individual with no apparent illnesses. On November 3, I had my first surgery in 40 years – a procedure for a detached retina (vitrectomy with a scleral buckle and pneumatic retinopexy; I read that off a brochure I received). I am not an expert patient and my impressions are of a single incident but I felt compelled to write about my particular patient experience along with my personal observations.
Medical Professionalism in 2011
As we celebrate the arrival of 2012, I’d like to take a moment and reflect on the ABIM Foundation’s accomplishments in advancing professionalism over the past year:
Putting the Charter into Practice Grantee: Johns Hopkins Bayview
This is the fourth in a series of posts written by the ABIM’s Foundation’s Putting the Charter into Practice grantees, which describes their motivation to pursue projects related to stewardship of resources.
Based on past experiences, both my co-investigator, Marc Larochelle, and I had an interest in improving stewardship of health care resources. Our paths converged and our interest met opportunity at an internal medicine housestaff morning report. Linda Mobula, a second-year resident at the time, presented the case of a patient whose symptoms, physical exam and laboratory findings were consistent with acute cholecystitis. An abdominal CT scan was obtained and demonstrated a thickened gall bladder wall and gallstones. A surgical consult was then obtained and, at the request of various providers, several additional tests, including a right upper quadrant ultrasound, HIDA scan and MRCP. Each test confirmed the diagnosis of acute cholecystitis. Many of us were struck by the fact that there was no clear rationale for ordering more than one diagnostic test. The conversation led to discussion of many other examples of potentially wasteful physician practices from routine daily lab tests to unnecessary imaging studies that cost much and add little, if any, value and may even cause harm.
Choosing Wisely
Today the ABIM Foundation announced the launch of the Choosing Wisely campaign. The goal of the initiative is to encourage conversations between physicians and patients about the overuse or misuse of tests and procedures that offer little benefit and may sometimes inflict harm.
Putting the Charter into Practice Grantee: University of Minnesota’s Division of Pediatric Emergency Medicine
This is the third in a series of posts written by the ABIM Foundation’s Putting the Charter into Practice grantees, which describes their motivation to pursue projects related to stewardship of resources.
When you ask people why they want to be doctors, nearly every answer includes a variation on the theme “to help people.” From the first day of medical school, with white coat ceremonies and recitations of the Hippocratic Oath, we are linked to a grand and ancient healing tradition. We all want to do the right thing. However, in the heat of the moment, working with a patient, our instincts about what that is aren’t always right.
Exploring What Works to Improve Care: Hold the Money, Pass the Praise
On November 18th, the American Board of Internal Medicine, through a grant from the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation and the ABIM Foundation, conducted a conference entitled, “Physician Level Assessment and Recognition: What Works?” The basis of the conference was a yet-to-be-published systematic literature review that compares the efficacy of pay-for-performance, pay-for-reporting, public reporting, assessment and feedback, and certification as means to improve the quality of health care.
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