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The Medical Professionalism Blog

Choosing Wisely is a Courageous Act

On April 4th, nine specialty societies will present lists of frequently performed tests and procedures that lack clinical evidence of their effectiveness – a poor use of limited health care resources. These specialty societies and the eight additional ones whose lists will be announced in the fall should be applauded for their great courage for taking this important first step in addressing the issue of sustainability and overuse of medical tests and procedures.

The Oxford Dictionary defines courage as “boldness and bravery.”

When I think about courage, I think about those who choose to travel down the more difficult path of doing what’s right when the easier path of least resistance begs them to walk its trail. Courage is speaking up when it’s the right thing to do, regardless of the personal implications.

Why are these specialty societies acting courageously in developing these lists?

1) They are doing what is right by announcing these lists to the public and their members without certainty of the reaction they will receive.

2)  They have a lot of experience in developing clinical guidelines and appropriate criteria but most have not developed such lists previously.

3) Helping their members understand the implications of these lists will take courage. Presenting their lists at meetings and in communication will be important. Some members will applaud them for participating and some (a minority) may not.

4) They have developed new partnerships with organizations, such as Consumer Reports and the consumer/employer members of the campaign, that most have not previously had.

5) Developing conversations among physicians and between patients and physicians about issues of optimal care and unnecessary care will be difficult.

Our goal with the Choosing Wisely campaign is to improve health care quality. We thank the specialty societies for their courage and leadership.

2 Comments to Choosing Wisely is a Courageous Act

  • April 4, 2012 at 1:37 pm | Permalink

    I am delighted to see the type(s) of steps being promulgated through the ABIM Choose Wisely initiative. As an advisor in healthcare for 40 years, I am proud to say that I am now working in national collaboration with a group of outstanding thinkers, i.e., health care writers/authors, policy analysts, physicians, and innovators who have been championing the restoration of order to health care management and delivery in this our broken system that is spending our children’s futures away. We have two key initiatives in our efforts to accomplish a return to sanity.

    First, we actively promote the reinvigoration of true primary care medicine in an effort to restore to quality doctor-patient relationships the rapidly disappearing elements of continuity, coordination and management of the whole patient. One of our pursuits is the introduction and implementation of PCMH clinics in American employers that can reach many individual who lack access to the benefits of primary care medicine. We have seen this in action and the stories are compelling.

    Second, we want to educate individuals about the necessity and the importance of asking questions before undergoing terribly expensive procedures – so many of which have proved wasteful, costly and harmful. It is time to stop the fee for service free-for-all that his driving us into the poor house. And, when expensive tertiary and quaternary care is necessary, we promote incentivized choices to use centers of excellence with demonstrably improved outcomes and cost efficiencies. This free choice is an economic benefit to both employers and employees, and offers some of the best care possible to those who choose to access it.

  • April 4, 2012 at 7:19 pm | Permalink

    Are you getting any flack yet from fellow physicians? I just read the news release. I refused a CT of the sinuses once and was really in disfavor at the EENT office – who did their own CT’s there.

  1. By on April 13, 2012 at 3:41 pm

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