A potentially game-changing health-care
initiative is underway in the USA. The Choosing
Wisely campaign is asking top physicians in different speciality areas
(e.g. cardiology, obstetrics, radiology) to identify the top five procedures or
tests that are routinely ordered by doctors but not supported by research. More
than 60 specialty societies have joined the campaign since its inception in
2012.
This campaign is about more than saving
money. Unnecessary tests and procedures not only increase health-care costs,
but also put patients at risk. Take CT (computed tomography) scans as an
example. A single CT scan delivers between 150 and 1,100 times the radiation of
a conventional x-ray. According to Scientific American, the National Cancer
Institute estimates that the 72 million CT scans performed in the USA in a
single year (2007) could cause up to 29,000 future cancer cases. That increase
is equivalent to about 2 percent of the total number of cancers diagnosed
nationwide every year. In some situations, CT scans are completely appropriate
and the benefits outweigh the risks. Many people, however, receive unnecessary
CT scans and, along with them, unneeded doses of radiation.
On a recent perusal of the Choosing Wisely website, I found no less
than 57 lists of ‘Five Things Physicians
and Patients Should Question’ created by different medical speciality
societies. Patient-friendly versions also have been produced in collaboration
with Consumer Reports. The Canadian Medical Association has recently joined the
effort and will be producing its own Top 5 lists in partnership with nine
Canadian physician speciality societies.
Patients are an important part of the
campaign because as care partners, they have a responsibility to ask questions
about the pros and cons of different treatment options. And sometimes, patients
ask for tests and treatments that are not in their best interests. Two classic
examples are requests for imaging (X-ray, CT or MRI scans) in the first few
weeks of a new episode of low back pain, or requests for antibiotics (which
kill bacteria) when all signs point to a viral infection. Research has shown
that physicians can be swayed by patient requests for specific tests or
treatments even when they disagree, sometimes because they want to please their
‘customer’ and sometimes because they want to avoid potential lawsuits.
Of course, general lists of things to avoid
can never substitute for a skilled clinician making decisions in collaboration
with the patient. And the American Board of Internal Medicine (ABIM) Foundation,
who is funding the campaign, notes that Choosing
Wisely recommendations should not be used to establish coverage decisions
or exclusions. Rather, they are meant to spur conversation about what is
appropriate and necessary treatment. As each patient situation is unique,
physicians and patients should use the recommendations as guidelines to
determine an appropriate treatment plan together.
Resources
Choosing Wisely Campaign website: http://www.choosingwisely.org
Patient-friendly materials: http://consumerhealthchoices.org/campaigns/choosing-wisely/#materials
When to say ‘Whoa!’ to doctors – a great
summary produced by Consumer Reports: http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyWhoaPkg.pdf
