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The Language of Choosing Wisely
In my last post about the 2012 ABIM Foundation Forum, I wrote about physician and patient competencies needed in the 21st century to achieve the triple aim (improving the patient experience, improved health of populations, and reduced per capita cost of health care). I was inspired by the thoughtful conversations that took place at the Forum exploring ways to improve our health care system, and I believe it’s these rich conversations that lead to changes in hearts and minds, and ultimately to actions and results.
In one of the Forum sessions, participants organized in small groups to develop approaches and messages about how they would talk with their respective constituencies—patients, physicians, policymakers, payers, purchasers and researchers—about appropriateness of care and reducing waste.
Language is important. In previous blog posts, I wrote about the issue of language and messages. I thought I would share with you some the words of the Forum participants. I think their ideas, advice and comments highlight how we as a community need to frame the issue of overuse and waste:
- Physicians should try to discover patients’ true preferences and desired outcomes when discussing what tests and procedures they need.
- Be careful placing too much emphasis on harm from tests and procedures.
- We need more patient stories of high-quality, coordinated care with appropriate services being delivered.
- Stories should also come from care teams, including the physicians, showing examples where good quality can cost less and that high cost doesn’t necessarily mean high quality. One participant noted that, “The secret in the care of the patient is in truly caring for the patient.” They further explained that this includes, “Do no financial harm.”
- There are often uncertainties in medicine and patients need to understand this through discussion with their health care team.
- Create a drum beat of persistent messaging with positive language.
- The rationing argument does not apply. Rationing is about denying care to those who need it. But efforts such as Choosing Wisely are about providing exactly the care that is needed.
- “More care does not always equal better care.”
What impresses me most about these comments is the positive framing of appropriateness—getting all the care that is needed through systems designed to address the needs of patients and families. Appropriateness and waste are not seen just as a physician not ordering tests, but as patients and physicians coming to a collective understanding of the reasons for and against using a specific test.
I am hopeful we can build on the positive thinking of Forum participants as we seek ways to address the challenges facing our health care system. With the latest estimates from the IOM that up to 30% of all health care spending is wasteful, thoughtful conversations between physicians, patients and other health care stakeholders will be needed to reduce unnecessary care and improve the system for all.
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