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- sean adams on The Influence of Ownership on Human Behavior: “Feeding the Beast”
- Sam Campbell on Unnecessary EKGs – The Heart of the Matter
- Lorna Lynn on The Influence of Ownership on Human Behavior: “Feeding the Beast”
I am going to confess something that may make me a pariah in the land of Eagles madness, not to mention among all of the fantasy football enthusiasts in our office.
I don’t like football.
Call me uptight, but it’s hard for me to kick back and enjoy a sport that causes significant brain damage in many of its players. Clearly, however, mine is a minority view. Professional sports such as football are big businesses that generate billions of dollars in annual revenue and have a profound influence on our culture.
In their recent Academic Medicine article, “Developing Physicians as Catalysts for Change,” the authors argue that medical schools’ emphasis on hierarchy and autonomy, as well as our fragmented health care system, contribute to physician burnout. To address these challenges, they argue that medical students should receive leadership training to empower them to act as catalysts to create health care system change. Ultimately, the authors envision a system in which physicians provide coordinated, team-based care in collaboration with other professions.
In his post “Unnecessary EKGs – the Heart of the Matter” (09.20.11), Dr. Stephen Smith wrote how owning a new EKG machine in his practice subconsciously motivated him to order more tests so he could justify the investment to his partner. He reaped no financial benefit from ordering more tests as he was paid on a salary, but he admits that “the financial interest of the practice had affected [his] clinical decision-making.”
Dr. Smith was an early leader of the Choosing Wisely® campaign through his work with National Physicians Alliance funded by the ABIM Foundation to curb unnecessary tests and procedures. If his professionalism could be corrupted by the simple act of owning a piece of equipment and feeling the need to justify its cost, you know that there is something more there than just financial greed. I call it the need to “feed the beast.”
For some time, the ABIM Foundation has featured a weekly Recommended Reading post containing brief descriptions of several recent articles on medical professionalism. We wanted to change the format of this weekly post to focus on a single recent article and discuss its significance in the field of medical professionalism. As we go forward, we welcome any suggestions for articles and your comments.
In the wake of the recent government shutdown, I have been thinking a lot about the “trust” that needs to exist between the public and institutions, and what the repercussions of losing that trust are.
Explore the latest articles on appropriate use of medical tests and procedures in this week’s Recommended Reading:
- A study published in NEJM examines urologists’ referral practices for intensity-modulated radiation therapy—a radiation treatment with a high reimbursement rate—for prostate cancer treatment. The author found that “Allowing urologists to self-refer for IMRT may contribute to increased use of this expensive therapy.”
- NPR’s Shots Blog cites the American Academy of Family Physician’s Choosing Wisely® recommendation regarding carotid artery screening in healthy adults in a post about potentially unnecessary health screenings.
- The New York Times discusses the AMDA’s Choosing Wisely recommendation on prescribing lipid-lowering recommendations in individuals with limited life expectancies.
Many factors can influence the professionalism of medical students and residents, from the cultures of their training institutions to their use of social media. Learn more in this week’s Recommended Reading:
- The authors of a JAMA commentary argue that academic medical centers must shift toward a culture of providing high-value care. ABIM Foundation trustee, Wendy Levinson, co-authored this piece.
- A Journal of General Internal Medicine article discusses the impact of moral distress in medical education and training.
- The authors of “Opting in to Online Professionalism” (subscription required) urge clinician educators to help students apply professionalism principles to their online behavior.
In his recent BMJ feature article, “The challenge of doing less,” Owen Dyer points out that the process employed by the Choosing Wisely® campaign has attracted criticism. In the article, Russell Harris, Director of University of North Carolina’s Center for Excellence in Clinical Preventive Services, states, “We did a systematic review and found that overall, the process is not transparent, it’s not evidence-based and it’s severely wanting.”
In fact, the process the specialty societies followed is quite the opposite.
- Each Choosing Wisely list includes a “How This List Was Created” section that describes the process and methodology for creating the five recommendations.
- The recommendations themselves include numerous references to the supporting evidence.
- Since the campaign was launched, 16 peer-reviewed articles have been published by the societies articulating their process and the evidence.*
Choosing Wisely® continues to spur conversations in the popular press and academic publications about stewardship of health care resources.
- The Robert Wood Johnson Foundation released its report Physician Network on Health Care Costs: Consensus Themes and Recommendations, which summarizes interviews with 18 physician leaders on ways to curb health care costs in the United States. The interviewees include ABIM Foundation Trustee Christine Sinsky and ABIM Foundation Putting the Charter into Practice grantee Neel Shah of Costs of Care.
- A Forbes piece examines the new American College of Emergency Physicians Choosing Wisely list.
- In a new Health Affairs piece, Mark Chassin, President and CEO of the Joint Commission, argues that quality improvement efforts to date have ignored the effects of overuse. He cites Choosing Wisely as an important new effort in addressing overuse.
Earlier this year, we launched the Teaching Value and Choosing Wisely Competition in conjunction with Costs of Care and the ABIM Foundation. Why a competition? Not surprisingly, traditional “literature review” yielded little by way of promising strategies for educators who wished to learn how to teach about value. However, we had all learned of isolated stories of success, occasionally through attending professional meetings, sometimes via networking with colleagues, or more often through just plain word of mouth. To help bring these stories of success to the fore, we relied on a crowdsourcing model by launching a competition to engage a larger community of individuals to tell us their story. Of course, there were moments we wondered if we would get any submissions. Fortunately, we did not have anything to worry about! In June, we received 74 submissions, from 14 specialties with innovations and bright ideas that targeted both medical students, residents, faculty and interprofessional learners.