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The Medical Professionalism Blog

Choosing Wisely: Harmonizing Clinical Guidelines to Improve Patient Care

When the original nine specialty societies were in the process of developing their recommendations as part of the Choosing Wisely® campaign, they asked ABIM Foundation staff how we would harmonize any that conflicted or appeared contradictory. Understanding the importance of each society’s contribution and respecting that they were the expert in their area, our response was that we would connect the two societies together and encourage a conversation to reconcile any differences. Surprisingly, with 45 recommendations and nine specialty societies, conflicts only arose in a few instances.

I recently spoke to a group of specialty society leaders about the list development process for Choosing Wisely recommendations. One of the CEOs of a society that had recently joined the campaign asked about harmonization of recommendations. Before I could respond, Douglas Henley, MD, EVP and CEO of American Academy of Family Physicians spoke up and said it was the job of the specialty societies to develop clinical guidelines when there were overlapping practice responsibilities. He further challenged the group to come together and jointly develop those guidelines.

I’ll admit to feeling in awe of Dr. Henley’s bold leadership – something I have witnessed more and more from specialty society leaders.

I had a similar experience when attending the recent American Board of Radiology (ABR) Foundation Summit– Safe Use in Medical Imaging: Developing a Systematic and Patient Centered Approach. Both the ABR Foundation and the American College of Radiology (ACR) have focused on the appropriate use of radiology procedures, recommended dosage, culmination of radiation over a patient’s lifetime and proper functioning and use of radiology equipment.

ACR has two awareness campaigns for physicians and patients called Image Gently® and Image Wisely®James Brink, MD is chair of diagnostic radiology at Yale University School of Medicine and co-chairs the Image Wisely Joint Task Force with E. Stephen Amis Jr., MD, chair of radiology, Albert Einstein College of Medicine.

In talking with Dr. Brink, he told me he often wondered why more specialty societies were not interested in the campaigns and why they weren’t involved in jointly developing clinical guidelines.

Given that most primary care physicians, medical subspecialists and surgeons order many of the radiology tests and procedures, it would follow that they would embrace the opportunity to join this effort. However, that is not yet the case.

Almost half of the current 45 Choosing Wisely recommendations are related to radiology use for headaches, lower back, prostate cancer, syncope, pre-operative tests, rhinosinusitis and abdominal pain syndrome, just to name a few.

I’m hopeful that Choosing Wisely is providing the right opportunity for societies to begin collaborating and harmonizing their guidelines where possible. This could take the form of specialty societies endorsing recommendations from other societies as part of the campaign.

Norm Kahn, EVP and CEO of the Council of Medical Specialty Societies (CMSS), recently shared some positive news that support for societies to undertake this effort is being developed through a set of “Principles for the Development of Specialty Society Clinical Guidelines” that will “create criteria by which guidelines are developed, to ‘raise the bar’ and set some common standards for guideline development.”

Developing common guidelines and messages for constituencies and the public will help patients better understand what tests and procedures are right for them. I am heartened by the work of CMSS, and to also see the beginning steps of this collaboration knowing that at least two specialty societies currently developing their lists will have two identical recommendations, and we are beginning to hear from other specialty societies who want to coordinate as well.

I applaud the work of all the specialty societies and encourage them to continue their efforts to harmonize their recommendations.

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