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As part of my Master of Public Health degree, I completed my master’s thesis at an HIV/AIDS clinic in Philadelphia where I evaluated a program that helped patients adhere to their antiretroviral medications. A key part of this program was the clinic’s pharmacist, who provided ongoing medication counseling. It was the first time that I really saw a pharmacist integrated into health care delivery and I greatly appreciated the insights and support she provided to patients. I also wondered why pharmacists aren’t more commonly seen as part of a patient’s health care team.
I thought the authors of the recent New England Journal of Medicine article, “Choosing Wisely — The Politics and Economics of Labeling Low-Value Services” presented the campaign in a thoughtful and balanced manner. On one hand, I was pleased with how the campaign was depicted—particularly the authors’ praise for the way it carefully created a space for physicians and patients to have conversations. This has been our vision since the very beginning.
This post was written by Giffin Daughtridge, a medical student at the University of Pennsylvania and a winner of the 2013 Teaching Value and Choosing Wisely Competition.
The timing of the e-mail I received announcing the Teaching Value Choosing Wisely competition could not have been better. One week earlier, I had met with Dr. Richard Shannon, then the Chair of Medicine at Penn and now the Executive Vice President of Health Affairs at the University of Virginia, to discuss a common interest we shared in generating high-value health care. We agreed that physician decision-making represented a powerful lever to improve value, and that decision-making skills were most malleable early in a clinician’s training. As such, we decided to develop a course for medical students to bring awareness to the impact of physician decision-making on both costs and quality of care.
The Super Bowl is upon is, and on Sunday much of the country will be busy watching the big game, eating 1.25 billion chicken wings, and of course critiquing the halftime show and commercials.
While the Super Bowl is a great deal of fun, serious injuries can also occur. With that in mind, I wanted to revisit my recent post on medical professionalism in sports medicine. Physicians working with professional sports teams may face conflicts between ensuring a player’s mental and physical well-being and the needs of the team.
This post was written by Cheryl O’Malley, MD, FACP, Program Director, Internal Medicine and Steven R. Brown, MD, FAAFP, Program Director, Family Medicine at Banner Good Samaritan Medical Center, University of Arizona College of Medicine – Phoenix. Drs. O’Malley and Brown were winners of the 2013 Teaching Value and Choosing Wisely Competition.
A little friendly competition is a good thing. We’ve seen it work in our residency programs. That’s why we answered the challenge of the “Teaching Value and Choosing Wisely Competition” with a competition of our own.
In last week’s New York Times article by Elisabeth Rosenthal, “Patients’ Costs Skyrocket; Specialists’ Income Soar,” we read about the plight of Kim Little, who lives 30 miles from Little Rock, Arkansas. She felt like a hostage when she was told she needed plastic surgery for the removal of non-cancerous mole instead of just a few stitches. She protested unsuccessfully against having the procedure. Her preferences were ignored because the protocol, according to her medical group, dictated otherwise.
At the 2011 ABIM Foundation Forum, Don Berwick gave a powerful talk on reducing waste in health care spending by targeting “wedges.” The wedges concept comes from environmental science research on reducing the trajectories of carbon dioxide levels over time. In their study, researchers concluded that there is no one magic solution–the problem must be tackled by addressing a number of discrete wedges that will collectively have a major impact.
The wastefulness of unnecessary EKGs is a subject that has been featured on this blog many times before, both by me and Dr. Stephen Smith, and a topic that has recently been highlighted in multiple Choosing Wisely ® lists.
When I was recently told I needed surgery for cataracts, I was sure I wouldn’t need a third preoperative EKG. The two I had previously were performed prior to the American Academy of Ophthalmology (AAO) and the American Society of Anesthesiologists (ASA) lists of recommendations, which state:
- “Don’t obtain baseline diagnostic cardiac testing (trans-thoracic/ esophageal echocardiography – TTE/TEE) or cardiac stress testing in asymptomatic stable patients with known cardiac disease (e.g., CAD, valvular disease) undergoing low or moderate risk non-cardiac surgery.” – ASA
- “Don’t perform preoperative medical tests for eye surgery unless there are specific medical indications.” – AAO
So when I was forced to get another EKG or abandon the surgery, I wasn’t going to let it lie. I felt empowered and well-informed by the backing of these two world-renowned specialty societies. Before the surgery, the anesthesiologist, Dr. B. (who turned out to be the Director of Anesthesiology) and I had a little chat:
The start of a new year marks the kickoff of the ABIM Foundation’s annual Professionalism Article Prize selection process. As the staff person in charge of compiling the previous year’s professionalism articles, this project gives me an opportunity to see the depth and breadth of the professionalism literature. We are in our fourth year of awarding the prize, and it is gratifying to see how the literature keeps growing as we continue to understand how to define, educate for, support and assess professionalism. Below are a few topics from 2013 that I hope are given further attention from researchers this year:
Every time I am invited to speak about the Choosing Wisely campaign, I ask the audience to raise their hands if they have witnessed or heard of unnecessary care delivered to patients, themselves and/or their family members. Usually, about three-quarters of them raise their hands. I then ask if they have witnessed or heard of cases where someone was harmed by unnecessary care and about a quarter still have their hands raised. Why do we hear more stories on misdiagnosis as a result of tests that were not ordered and not the stories where unnecessary tests caused harm? Sharing such anecdotes is an important component of increasing awareness of wasteful tests and procedures.