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The Medical Professionalism Blog

Choosing Wisely®: Kinder Ways of Thinking About Resource Use

The goal of the Choosing Wisely campaign is to encourage conversations between patients and physicians about what tests and procedures are, or are not needed. We hope these conversations provide an opportunity to talk about the benefits and risks of tests and procedures, including potential harms for patients. Choosing Wisely is about thoughtful discussions and shared decision-making with informed patients and physicians with an aim of making wise choices about treatment options, based on the individual needs and desires of the patient.

A recent op-ed in The New York Times (10.7.12) by Bill Keller, How to Die, discusses the need to focus on patients’ (and families’) wants and desires, (not cost) when speaking about the issue of dying. He presents the Liverpool Care Pathway for the Dying Patient as an example and how it helps guide care to allow a peaceful and patient-directed pathway toward death. The guideline’s purpose is not to save money.

Keller is bewildered when Americans talk about saving money at the end of life and states that it is “both questionable economics and bad politics.” In fact, the op-ed points to research by Zeke Emanuel that “concludes that with the possible exception of hospice care for cancer patients, measures to eliminate futile care in dying patients have not proved to be significant cost-savers.”

The Choosing Wisely campaign focuses on conversations about recommendations from the specialty societies so that only necessary patient-centered care is provided, and care that can be harmful or of no benefit is avoided. The campaign has helped stimulate conversations between patient and clinicians and the larger community about reducing overused tests and procedures that are not supported by evidence.

The critical issue of how we would like to die can be fraught with emotion and fear, but having conversations with trusted family members, friends and our physicians can help assuage those concerns and lead us on a path that ensures our wishes are well-known and respected. As others have written, most people do not want to die in the hospital hooked up to machines, but rather at home surrounded by loved ones. This is not about rationing care or the hyperbole of death panels. This is about respect.

I think Bill Keller’s courageous op-ed is right on target. What do you think?

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