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- In The Recent Reversal of the Growth Trend in MRI: A Harbinger of the Future?, the authors report that MRI utilization rose sharply from 1998 to 2008 then declined from 2008 to 2010. They cite a number of possible causes for the recent decline, and say that Choosing Wisely and other initiatives may contribute to a further decline in MRI use.
- The editor of FierceHealthFinance discusses the problems of unnecessary tests and procedures and overdiagnosis from both personal and health policy perspectives.
- In Neurology Now, Dr. Orly Avitzur highlights several of the Choosing Wisely recommendations, and says that “this is a movement with considerable momentum, and one that will change what you hear at the doctor’s office.”
At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring, the problem is not new.
Catch up on the latest literature on professionalism in medical education in this week’s Recommended Reading:
- The authors of “e-Professionalism: A New Frontier in Medical Education” discuss the challenges posed by e-professionalism, which they define as “attitudes and behaviors that reflect traditional professionalism paradigms but are manifested through digital media.”
- The study “Narrative medicine as a means of training medical students toward residency competencies” explores the impact of a narrative medicine curriculum on communication, collaboration and professionalism skills.
- The authors of “Passing the torch: A proposed amendment to ‘A Physician Charter’” propose adding a “Principle of Generativity: Physicians must contribute to the education and development of the next generation of practitioners in order to ensure that the profession lives on and thrives, grounded in its fundamental professional values.”
The Choosing Wisely® campaign has attracted a lot of attention from the so-called “grasstops” in the form of physician leaders, policy makers, researchers, delivery system leaders, journal authors and the media. This top-down strategy was necessary given a political environment that invoked terms such as “rationing” and “death panels.” Yet, the “grasstops” strategy of the Choosing Wisely campaign has sparked conversations about wasteful tests and procedures among leaders and organizations and has helped legitimize such conversations—and more importantly, actions—among those who can put words into action; moving the campaign from grasstops to grassroots. Cardiologist and American College of Cardiology leader, Dr. Blair Erb, in his “Curbing Overuse” cover story in Modern Healthcare, said, “What Choosing Wisely has done is legitimize our ability to cut back on what’s unnecessary.”
Learn about the roles of patients and physicians in managing health care resources in this week’s Recommended Reading:
In “Educating Physicians about Responsible Management of Finite Resources,” ABIM/ABIM Foundation President & CEO Christine K. Cassel, MD and co-authors advocate for physician education in “health care waste, abuse, fraud, and the ethical underpinnings of physician decisions, particularly where waste transitions to incentive-driven behavior.”
A Forbes article describes the challenges with engaging patients in managing health care costs and potential solutions for these challenges. Among the solutions mentioned is the Choosing Wisely® campaign.
In the recent JAMA commentary, “Pushing the Outpatient Quality Envelope,” Tara F. Bishop, MD, MPH argues that the health care community needs to develop more quality measures in a number of areas, including judicious use of health care resources. Dr. Bishop cites the Choosing Wisely campaign as one good starting point for developing these measures.
This post first appeared on Informed Medical Decisions Foundation‘s blog.
The patient-physician relationship of yore was pretty much one-sided. Physicians used to tell their patients what tests and procedures needed to be done and didn’t really offer much information on their condition, nor were patients asked to be involved in decisions regarding their own care. That relationship has begun to change dramatically; patients want and are given more information, and they are more involved. There is a growing body of research that points out the benefits of patient engagement. There is more information flowing from physician to patient; patients are now seen as an excellent source of information when taking their history and their preferences are carefully considered – “nothing about me without me.”
These informed conversations are central to the objectives of the Choosing Wisely® campaign. By the end of 2013, more than 40 specialty societies will recommend over 200 tests and procedures that should be questioned by patients and physicians. Based on the best available evidence, the campaign seeks to provide patients with information on tests and procedures deemed to have more risk than benefit by specialty societies. Physicians will build communication skills through education modules produced by the Drexel School of Medicine to effectively and efficiently provide the necessary explanations and reassurance patients need when electing to forgo a specific test or procedure. The patient-physician relationship is no longer one-sided: it is an informed conversation between the two about what is in the best interest of the patient.
We can only hope to eliminate waste and keep patients away from potential harm from unnecessary care by making patients central in decisions about their care even when evidence is not totally conclusive. Research shows that patients aren’t what they used to be and thank goodness. We couldn’t—and shouldn’t—have these conversations without them.
This week’s Recommended Reading spotlights the latest research on medical professionalism in education and practice:
- Faculty from the Department of Surgery at the University of North Carolina, Chapel Hill examined the impact of a six-week professionalism curriculum on the attitudes, knowledge and behaviors of an academic plastic surgery practice. The course was comprised of lectures, small group discussions, and journal and book reviews. They found that the course resulted in improvements in knowledge of professionalism, but not necessarily attitudes.
- Researchers from Massachusetts General Hospital assessed safety-net physicians’ attitudes toward—and participation in—quality improvement activities compared with non-safety-net physicians. They found no difference in the two groups’ participation in quality improvement, but found that safety-net physicians were more likely to assess racial and ethnic disparities in their practice.
- ABIM/ABIM Foundation President & CEO Christine K. Cassel, MD co-authored a new JAMA commentary, “Educating Physicians About Responsible Use of Finite Resources.” The piece discusses the roles of undergraduate and graduate medical education, licensure and specialty certification in fostering the wise use of healthcare resources.
Arriving in a train station in a Northeast city the other day, I was struck by the number of advertisements for proton therapy at a local academic medical center (AMC) plastered throughout the station and in local subways. The ads feature a bicycle racer with the tag line: “THE WIND IN YOUR FACE IS WORTH PROTON THERAPY: A cancer treatment that has fewer side effects.”
Catch up on the latest articles on medical professionalism, courtesy of this week’s Recommended Reading:
- The authors of Ethical Physician Incentives — From Carrots and Sticks to Shared Purpose argue that a healthcare organization’s incentive schemes should align with the goals articulated in the Physician Charter.
- In a Robert Wood Johnson Foundation blog post, Drs. Kevin Volpp and David Asch discuss low-value health care and the role of Choosing Wisely® in the wise use of health care resources.
- A Washington Post blog post, “What your doctor isn’t telling you,” cites Choosing Wisely as part of a “burgeoning movement in medicine right now to cut back on unnecessary treatment or overuse of care.”
As an employee of the ABIM Foundation, I’ve batted around the phrase “medical professionalism” for several years but it didn’t really hit home for me until I encountered it – and the lack thereof – as a patient.
Over the past six months, I’ve logged a few miles in the frequent patient program. I underwent a 13-hour craniotomy to resect a meningioma and woke up from surgery with nerve damage to my left brachial plexus. I have consulted doctors up and down the East Coast, from some of the most prestigious health care systems. When it comes to finding a good doctor, I do my research. But exemplary skills as a surgeon, as I well know, don’t necessarily translate to practicing “professional” medicine.