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Social Justice and Choosing Wisely®: Radical Idea or Basic Tenet?
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.
In thinking about Choosing Wisely’s future, I was reminded of my past. Twelve years ago, when I began working for the ABIM Foundation, I read the Physician Charter and was immediately attracted to its fundamental principle of social justice. There are many definitions of social justice in health care but the dozen writers from ACP Foundation, European Foundation of Internal Medicine and ABIM Foundation were quite explicit about what it meant in relation to the health care community:
The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion or any other social category.
There is a connection between this principle of social justice and the fundamental tenets behind Choosing Wisely. For example:
- The campaign could be seen as a means to level the playing field for all patients in that it broadens access to needed care by identifying what tests and procedures are not necessary and by eliminating waste.
- Providing wasteful health care services makes it more difficult to access care that is actually needed. If a clinical office has the capacity to deliver 50 x-rays in a day and 25 are not necessary, patients that need the test are forced to wait. Usually, those who have most difficulties getting access to care are disadvantaged populations.
- In order to preserve the sustainability of our system, health care resources need to be distributed to patients that need care. They should not be wasted on care that has no benefit and could be potentially harmful. Wasteful services adversely affect the focus on improving the health of the population. The resources used up by wasteful health care expenses could be better spent on improving education and infrastructure. Rosemary Gibson, author of Medical Meltdown, reports that roads and infrastructure go unattended in China, Maine, because of the high costs of care partially due to unnecessary care.
If we are to have a high-quality and affordable health care system, the just distribution of services needs to be a basic tenet of the medical profession and society. Through Choosing Wisely, the profession can examine the consequences of waste on larger societal issues and hopefully change things for the better.
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