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“In every job that must be done, there is an element of fun. You find the fun and – SNAP – the job’s a game!”
Who knew that Mary Poppins’ advice could apply to reducing waste in health care? Apparently, the Society of Hospital Medicine (SHM) and the Minnesota Medical Association (MMA) did. To get their members fired up about implementing Choosing Wisely, both organizations are inviting their members to engage in a little friendly competition.
The following is a commencement speech given at the University of Texas Southwestern Medical School’s 2014 graduation ceremony.
Your institution has ceded to me the last 15 minutes of your medical school instruction – how should I use it? One more time through the complement cascade? Or, as Dr. Seldin might have it, a final discussion of salt wasting in chronic renal disease, or, perhaps, the causes of metabolic acidosis? My guess is that you would sleep through that (as I slept through so many medical school lectures), but the good news is that many of those things are going to change–dramatically–over the course of your careers. Change in medicine is a constant, sort of. Many things DO change, but some core things don’t. Let’s spend some time reflecting on that. Read more »
This past April, the Choosing Wisely campaign celebrated its second anniversary. As is the case with the passing of any milestone, I have been reflecting on what the campaign has achieved and what we have yet to accomplish. It also made me take stock of the environment in which we incubated this concept and launched the campaign, as well as how the landscape has changed.
Overtreatment has been on the minds of journalists, politicians, patients and physicians in this country over the past few years. The Choosing Wisely campaign was launched amid the passing of the Affordable Care Act and nascent conversations around health care costs and stewardship. I’d like to think that Choosing Wisely has had an impact on those conversations.
I am pleased to announce the publication of a new textbook sponsored by the ABIM Foundation entitled Understanding Professionalism, written by Shiphra Ginsberg, MD, Fred Hafferty, PhD, Foundation trustee Wendy Levinson, MD, and former trustee Catherine Lucey, MD. While the book’s subject matter is not new to medical education curricula, the way it presents professionalism is, in my opinion, truly impressive.
As noted in a previous blog post, Choosing Wisely is gaining traction abroad. Global initiatives include Choosing Wisely Canada, Choosing Wisely Netherlands and “Slow Medicine” in Italy. I am fascinated by the different ways other countries are promoting the campaign to physicians and patients, and leveraging it to tackle issues prevalent in their particular health systems.
I recently spoke to several health system/hospital quality experts and physician groups in Upstate New York about the Choosing Wisely campaign. I was looking forward to speaking about the campaign to a hometown crowd (I was born and raised in Syracuse) and an audience that included my former next-door neighbor, the regional president of Excellus. The campaign has been so well-received by audiences all over the country, I was expecting a particularly warm reception at home. How wrong I was!
A number of specialty organizations have identified preoperative testing (i.e., lab tests, x-rays and cardiac testing) in healthy patients undergoing low-risk surgery as a frequently overused service and have included it on their Choosing Wisely® lists of tests and procedures that may be unnecessary. As preoperative testing may be ordered or requested by a multiple groups of physicians—surgeons, anesthesiologists, general internists or pediatricians or medical specialists—ensuring its appropriateness is complex. On April 30, the New York Academy of Medicine (NYAM) and the ABIM Foundation sponsored a multispecialty panel discussion to define appropriate preoperative testing and to discuss:
- potential harms of overtesting;
- reasons why overtesting is common; and,
- strategies to optimize testing.
Since the ABIM Foundation created the Professionalism Article Prize in 2011, I have been amazed by the thoughtfulness that goes into selecting the winners. After a review of a year’s worth of literature by Foundation staff, a select committee narrows down more than a hundred articles on various aspects of professionalism to the three they deem most important. For this, the committee deserves a special thank you.
It’s incredible to see Choosing Wisely spread throughout delivery systems, local communities and internationally. To see it grow in residency programs gives me particular joy knowing that the next generation of physicians will have competencies in stewardship and systems-based practice that surpass the current physician workforce.
Last week, 21 sub-grantees of the Robert Wood Johnson Foundation assembled at the Choosing Wisely Summit to learn from each other, advance skills to spread the awareness of the campaign and plan for the future. The event was a great success; I felt that all of the grantees were re-energized after sharing their stories and learning about the work of their peers. One of the simplest yet most profound takeaways from the meeting—for me, at least—was the reminder of the old adage, “if at first you don’t succeed, try again.”