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A week has passed since the wrap-up of the 2014 ABIM Foundation Forum: Rebooting the System for Service and Satisfaction, and I’m still buzzing from the incredible energy and enthusiasm of the participants in the room.
The topic of this year’s meeting centered around the role of technology in medicine and obviously touched a nerve. There isn’t a physician among us whose work hasn’t been affected by the proliferation of health IT. It was therefore fitting that, as we discussed various strategies for implementing IT into practices and larger organizations, we also talked about how physicians are suffering high levels of burn-out and strategized ways to bring back joy in practice. While at present, IT and joy in practice seem diametrically opposed (as the pressure clinicians are suffering from is, in part, a result of the increased demands of technology), it is important to realize how one can facilitate the other if the IT system is properly designed and implemented.
From August 3-5, over 150 national leaders representing consumer groups, physician organizations, medical students and residents, policymakers, accreditors, certifying boards, journal editors, researchers, health plans and employers will discuss the positive and negative consequences of technological innovations in medicine and associated regulations on patient care and the effect on physician well-being. Individuals with acute or chronic conditions or disabilities have also been invited to participate – as is the case with every Forum, their contribution is invaluable.
I recently received an e-mail from a frustrated physician who expressed his concerns to me about HealthFair, a company providing screening services at his local academic medical center. Tuned into the Choosing Wisely® campaign, the physician claimed the cardiovascular screenings HealthFair was offering (echocardiograms and electrocardiograms) went against the specialty societies’ recommendations.
“In every job that must be done, there is an element of fun. You find the fun and – SNAP – the job’s a game!”
Who knew that Mary Poppins’ advice could apply to reducing waste in health care? Apparently, the Society of Hospital Medicine (SHM) and the Minnesota Medical Association (MMA) did. To get their members fired up about implementing Choosing Wisely, both organizations are inviting their members to engage in a little friendly competition.
The following is a commencement speech given at the University of Texas Southwestern Medical School’s 2014 graduation ceremony.
Your institution has ceded to me the last 15 minutes of your medical school instruction – how should I use it? One more time through the complement cascade? Or, as Dr. Seldin might have it, a final discussion of salt wasting in chronic renal disease, or, perhaps, the causes of metabolic acidosis? My guess is that you would sleep through that (as I slept through so many medical school lectures), but the good news is that many of those things are going to change–dramatically–over the course of your careers. Change in medicine is a constant, sort of. Many things DO change, but some core things don’t. Let’s spend some time reflecting on that. Read more »
This past April, the Choosing Wisely campaign celebrated its second anniversary. As is the case with the passing of any milestone, I have been reflecting on what the campaign has achieved and what we have yet to accomplish. It also made me take stock of the environment in which we incubated this concept and launched the campaign, as well as how the landscape has changed.
Overtreatment has been on the minds of journalists, politicians, patients and physicians in this country over the past few years. The Choosing Wisely campaign was launched amid the passing of the Affordable Care Act and nascent conversations around health care costs and stewardship. I’d like to think that Choosing Wisely has had an impact on those conversations.
I am pleased to announce the publication of a new textbook sponsored by the ABIM Foundation entitled Understanding Professionalism, written by Shiphra Ginsberg, MD, Fred Hafferty, PhD, Foundation trustee Wendy Levinson, MD, and former trustee Catherine Lucey, MD. While the book’s subject matter is not new to medical education curricula, the way it presents professionalism is, in my opinion, truly impressive.
As noted in a previous blog post, Choosing Wisely is gaining traction abroad. Global initiatives include Choosing Wisely Canada, Choosing Wisely Netherlands and “Slow Medicine” in Italy. I am fascinated by the different ways other countries are promoting the campaign to physicians and patients, and leveraging it to tackle issues prevalent in their particular health systems.
I recently spoke to several health system/hospital quality experts and physician groups in Upstate New York about the Choosing Wisely campaign. I was looking forward to speaking about the campaign to a hometown crowd (I was born and raised in Syracuse) and an audience that included my former next-door neighbor, the regional president of Excellus. The campaign has been so well-received by audiences all over the country, I was expecting a particularly warm reception at home. How wrong I was!
A number of specialty organizations have identified preoperative testing (i.e., lab tests, x-rays and cardiac testing) in healthy patients undergoing low-risk surgery as a frequently overused service and have included it on their Choosing Wisely® lists of tests and procedures that may be unnecessary. As preoperative testing may be ordered or requested by a multiple groups of physicians—surgeons, anesthesiologists, general internists or pediatricians or medical specialists—ensuring its appropriateness is complex. On April 30, the New York Academy of Medicine (NYAM) and the ABIM Foundation sponsored a multispecialty panel discussion to define appropriate preoperative testing and to discuss:
- potential harms of overtesting;
- reasons why overtesting is common; and,
- strategies to optimize testing.