The Medical Professionalism Blog
Recommended Reading: April 5-12, 2012
This Recommended Reading installment features coverage of the ABIM Foundation’s Choosing Wisely® campaign, which attracted television, radio, newspaper and blog coverage and set the Twitterverse abuzz. Enjoy!
- A New York Times editorial asked, “Do You Need that Test?”
- Former CMS head Don Berwick argues that, with this campaign, “Physicians Step to the Front in Health Care Reform.”
- Kevin Pho of KevinMD fame, weighed in with his support of the campaign, urging doctors and patients to “talk more, test less.”
- Blogger Dr. John M called Choosing Wisely® “a great name for a great plan,” and has already proposed his own “Top Five” list for electrophysiology.
Fresh Air in the Capital and Throughout the Nation
Last week marked the start of a different type of conversation about the appropriate use and reduction of unnecessary care in the U.S. health care system.
On April 4, nine specialty societies made public their lists of “Five Things Patients and Physicians Should Question.” Many national and local newspapers, broadcast media and blogs covered the story in ways that were refreshing. There were thousands of tweets and comments on blogs, and more than 100,000 visits to www.choosingwisely.org within the first 72 hours of the announcement.
Medical Professionalism in Action
As we all know, this is a time of great challenge and introspection in our health care system. Not just in terms of health reform – although that has been the catalyst for several critically important conversations over the last two years. I’m referring to a broader reexamination of how we deliver care in America and what physicians, working with their patients, can do to ensure the highest-quality care.
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 Importance of Choosing Wisely
On April 4th as part of the Choosing Wisely™ campaign, nine medical specialties will announce their lists of five tests and procedures patients and physicians should question due to lack of evidence about their benefits.
The nine specialty societies 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
On that same date, we will also welcome eight additional specialty societies to the campaign whose lists will be developed and announced in the fall.
Why is this campaign so important?
In Defense of Doctors’ Feelings
An op-ed piece written by by Danielle Ofri in the March 28 edition of the New York Times relays the emotional toll having “difficult conversations” with patients can have on a physician. In one anecdote, Dr. Ofri mentions that she, and the rest of the patient’s health care team “fell short of the Charter on Medical Professionalism” and its commitment to honesty with patients.
First and foremost, doctors need to be honest with their patients as put forth in the Charter. As Don Berwick says, “Nothing about me without me.”
The physician has an obligation to break bad news to patients. And it’s incredibly difficult, I’m sure. But residents and medical students are trained in how to give bad news and many institutions provide peer support for the well-being of physicians about situations that are emotionally charged. There’s no doubt that the well-being of the physician is important but honesty with patients about their conditions, no matter their payment or citizenship status, is paramount. They have the right to know.
Dr. Ofri collected herself and was able to do the right thing. This piece is important because these situations are hard on physicians and society, hospitals, patients and caregivers all need to be understanding of this difficult predicament.
The Words Used to Talk About Use of Resources: What Do They Tell Us?
The words we use to talk about the use of health care resources makes a difference in how we engage physicians, clinicians and patients in thoughtful discussion around the economic sustainability of the current health care system. These conversations must happen — without hysteria and political motivation. We need attitudinal and political changes before we can have behavioral changes.
Recommended Reading: March 16-23
How can we address our nation’s spiraling health care costs? This week’s Recommended Reading offers several potential solutions:
As Ezra Klein reports, Victor Fuchs and Ezekiel Emanuel have proposed cutting the length of medical training by 30 percent, thereby reducing physician debt and allowing space for more physicians to be trained.
The Wall Street Journal Health Blog reports on La Crosse, Wisconsin’s success with reducing the costs of advanced illness. Leaders of the La Crosse program estimate that their model could save $25 billion annually if adopted nationwide.
Is focusing on geographic variation in health care costs the answer? Not so fast, say authors of a recent systematic review on variation in costs by region. Instead, “more of our efforts should be directed at designing policies that will reduce inappropriate care in general, regardless of region.”
A Question of Worth
Costs of Care (Twitter: @CostsOfCare), where this post was originally published, is a Boston-based, non-profit organization that helps caregivers deflate medical bills and provide high value care. As part of the 2011 Costs of Care Essay Contest, more than 100 anecdotes were shared by patients and providers around the country that illustrate the role of cost-awareness in medicine. These stories will help expand the public discourse on the power clinicians have to curb costs.
The following anecdote is written by Dr. Eijean Wu, is a gynecologic oncology fellow at the University of Southern California Medical Center, and a finalist in the 2011 Costs of Care Essay Contest.
As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much.
Hope is On the Way for Primary Care Practice
At a March 12 conference sponsored by the ABIM Foundation, we heard descriptions on how primary care can and should be improved to:
- enhance the patient experience;
- improve quality and
- bring joy back into practice.
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