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The Medical Professionalism Blog

Choosing Wisely

Today the ABIM Foundation announced the launch of the Choosing Wisely campaign. The goal of the initiative is to encourage conversations between physicians and patients about the overuse or misuse of tests and procedures that offer little benefit and may sometimes inflict harm.

In an era of increasing health care costs that consume a growing percentage of the nation’s resources coupled with evidence that the U.S. lags behind other advanced nations in delivering quality care, these are important conversations for us to have. The U.S. spends twice per capita what other major industrialized countries spend on health care, yet has an average life expectancy of 78.3 years, placing it 35th in the world.

In this effort, the ABIM Foundation is partnering with nine medical specialty societies, representing more than 376,000 physicians. The Choosing Wisely partners include:

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians
  • American College of Cardiology
  • American College of Physicians
  • American College of Radiology
  • American Gastroenterological Association
  • American Society of Clinical Oncology
  • American Society of Nephrology
  • American Society of Nuclear Cardiology

Each medical specialty society is developing a list of five common tests or procedures whose necessity in their profession should be questioned and discussed. The resulting lists will be publicly unveiled in April 2012.

Consumer Reports has also joined the campaign and will create resources to help consumers engage in these important conversations.

This campaign aims to promote open and frank conversations about tests and procedures whose potential harms may outweigh their benefits. It’s about improving quality of care by removing those things that don’t bring any value to the patient or physician.  Removing waste is improving quality of medical care.

There will be some quarters that may demonize this campaign and infer the “R word” – rationing. Make no mistake on what rationing is: the denial of medical care that provides benefits to the patient. Rationing occurs when people are uninsured and don’t receive the care they need. It occurs when non-English speaking patients are not provided translators in the location they receive care.

The nine specialty societies that have come on board should be applauded for their tremendous leadership and professionalism. The Hippocratic Oath, to which all physicians aspire to uphold, states, “First, do no harm.” Further is the commitment to be trustworthy and put the interest of the patient above all else. These medical societies are standing up for social justice through a fair distribution of resources as set forth in the Medical Professionalism in the New Millennium: A Physician Charter.

Through Choosing Wisely and the collective efforts of the medical specialty societies and Consumer Reports, I am confident we are taking an important and potentially monumental step toward achieving the Charter’s ideals.

For more information on Choosing Wisely, visit www.choosingwisely.org.

7 Comments to Choosing Wisely

  • November 14, 2012 at 10:28 am | Permalink

    I applaud your efforts. As an anesthesiologist I can attest to the number of unnecessary pre-operative testing that occurs routinely. While some of those who comment on this site don’t agree with your agenda, insurance companies will be looking at these things closely and limiting them for us if we don’t do it ourselves. I will link to this site on my blog http://www.medicineforreal.wordpress.com
    Shirie Leng, MD
    Harvard, Beth Israel Deaconess Medical Center, Boston

  • Lori's Gravatar Lori
    January 19, 2012 at 11:08 am | Permalink

    Should all skin spots that are removed (out of concerns for potential skin cancer) be tested for skin cancer? My mom just had a spot removed because it was growing and looked unusual, and the dermatologist just froze it then burned it off – no testing. Relatedly: Is the 5% cream Aldara useful in prevention of serious skin cancers, in patients that have had suspicious-looking skin spots removed? That same dermatologist told her that the treatment was expensive, so he wouldn’t prescribe it, even though she has had two unusual skin growths removed within 6 months of each other – and she used to get burns and tans a lot, as she was an outdoor jogger and bicyclist and only recently started wearing sunscreen. I cannot find this information online, and do not trust her doctor. The work being done by ABIM is very important, because we need evidence-based treatment information made public in a way that non-medical-professionals can understand.

  • Roxana Voica, MD's Gravatar Roxana Voica, MD
    January 6, 2012 at 1:16 pm | Permalink

    I agree that considering life expectancy as a measure of the medical care quality is a dangerous stereotype which negatively impacts not only the hospitals, insurance companies but physicians as well. Our representative societies should know better.
    We never talk about the number of violent deaths, for example due to gunshot wounds or motor vehicle accidents or drug usage. How about cocaine babies? There are more cars per capita in this country, therefore a potentially higher number of motor vehicle accidents.. These indicators do affect the life expectancy.
    I think that the quality of the health care in USA is spectacular, especially when we take into account that the US population is not homogenous in terms of education and culture. It is unfair to compare life expectancy in the US with that in Norway, where the population is much more homogenous. If you never experienced health care in another country, you are apt to believe the distorted information that media presents.

  • Robert A. Struble, M.D.'s Gravatar Robert A. Struble, M.D.
    December 28, 2011 at 12:32 pm | Permalink

    When prefacing a request by citing worldwide life expectancy data, I become suspect as to where this is headed. Assuming the academy is truly interested in cost control, and not just self-flagellation for the sake of political correctness, I suggest the following.

    We can nitpick among our board certified brethren about the who, what, how, and whys of allergy testing and immunotherapy but let’s root out the most egregious practices first. As I see it , this includes “alternative” medicine bunch with their unproven nostrums, tests, diets, etc., and ENT physicians who are deciding to “do allergy” more and more in recent years, often at great odds to the accepted standards of our AAAAI. Thoroughly educate the public regarding these pitfalls first and then let our nitpicking (relatively speaking) begin.

    To digress, the demographic group with shortest life expectancy in the US is already enrolled in or eligible for “free medical care”. It’s not the quality or quantity of health care that is their issue but rather education, cultural mindset, and lifestyle choices. The inclusion of life expectancy or infant mortality in any discussion of physician effectiveness is a specious statement at best.

    • Stephen Parsons, M.D.'s Gravatar Stephen Parsons, M.D.
      April 12, 2012 at 8:11 pm | Permalink

      Dr. Struble,
      I and many other ENT physicians “do allergy” as you put it, because it falls fully within our specialty (at least for inhalent allergies -I’ll leave the food allergies to you). The most bothersome allergy symptoms are in the eyes/nose/ and throat – areas which I am much more qualified to examine and treat either medically or surgically than you are. We are trained during residency in allergy, and those of us who treat patients follow the accepted standards of the AAOA. Who are you to say the AAAAI is only Academy that one can follow? What is truly “egregious” as you like to say, is the recent board certified allergist who told my 4 year old patient’s parents that he couldn’t breathe because of a deviated septum. The truth was he had gigantic adenoids which I removed, and cured his breathing. So please stop picking fights with other medical specialties – it doesn’t help any of us in medicine.

  • bob lanier's Gravatar bob lanier
    December 21, 2011 at 10:41 am | Permalink

    you are collaborating with organizations advocating medical home and lessening the impact of specialists.

    By creating these lists, you are making mini-practice parameters without the time and effort associated with practice parameters.

    The expenses generated by these procedures if totally removed will reduce spending by a fraction of a fraction of a percent.You are doing a symbolic action, nothing substantial. This is the equivalent of wearing a pink ribbon so you an say you care more about breast cancer than those who do no wear the ribbon.

    All you will wind up doing is creating negative press for allergists at a time we don’t need it.

    Don’t be so excited about self-flagellation

    • Daniel Wolfson's Gravatar Daniel Wolfson
      December 22, 2011 at 4:01 pm | Permalink

      Dr. Lanier,

      Thank you for your comment. The goal of the campaign is to get physicians and patients engaged in a conversation about overuse and misuse. It is about appropriateness of care as defined in specialty societies’ own clinical guidelines and appropriateness criteria. Both primary care and specialty societies are a part of this effort. This is about not doing things that have no benefit or where the benefits don’t exceed the potential harm to patients. We are saying these tests or procedures should be questioned and should be performed under certain circumstances.

      I think we can agree there is waste in the health care system- some say as much as 30%- and it’s through the leadership of the these specialty societies that patients will only receive care based on sound evidence that provides the most benefit.

  1. By on January 20, 2012 at 10:12 am

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