The Medical Professionalism Blog

As ABIM and ABIM Foundation President and CEO Chris Cassel pointed out in her recent post, the Choosing Wisely® campaign is medical professionalism in action. But this is not professionalism where protectionism is being professed. Rather, the profession has taken the bold and brave step of not only identifying the tests with little value but welcoming a partnership with Consumer Reports and other consumer and employer groups.  Physicians are taking the lead, and patients and all stakeholders appear to welcome this change.

What is powerful about the Choosing Wisely campaign and other similar efforts (e.g., American College of Physicians,  the National Physicians Alliance and the Archives of Internal Medicine) is what can happen when physicians are empowered to provide leadership and speak out about important issues such as appropriateness and waste. The potential attitudinal and cultural changes about waste and overtreatment can, as Don Berwick said, be a “game changer.”  Driving forces behind high-performing delivery systems have been leadership, culture and values; all of which lie at the core of the Choosing Wisely campaign.

Delivery systems are now beginning to think about how to implement the recommendations of the societies. There is complexity in implementing any intervention that results in changes in clinical practice. In addition, there is complexity in measuring changes in utilization – the societies’ recommendations are not absolutes. There are lots of exceptions based on individual patient history and preferences. Understanding these complexities of implementation will take time, but it is a necessary step to avoid a rush to evaluation and accountability.

As Don Berwick stated, “Payers, even while they celebrate the step of professional leadership, should exercise restraint in converting these lists into hard-wired payment rules.”

The ABIM Foundation is in this for the long run and we look forward to watching this campaign grow and mature. Already 10 more specialty societies have joined the original nine specialty societies (and others are considering it). Consumer Reports will be creating and distributing patient-focused explanations of the specialty society recommendations. This is proving to be a viral campaign – many conversations are occurring among physicians and patients without government and payer interventions. Lots of organizations are thinking about implementing strategies.

The time has come to give this kind of professionalism a chance.