Philly-based organization ABIM Foundation, which works on issues pertaining to medical professionalism, launched a new initiative today called Choosing Wisely. It roped in nine physician associations—with more to come—who created lists of tests, procedures and treatments they believe are often unnecessary and overprescribed. The goal is to help patients and doctors make more informed decisions about healthcare and to keep patients from getting procedures they don’t need.
The nine lists, which include five recommendations each, come from well regarded physician specialty groups that represent 374,000 physicians. For example, the American Academy of Family Physicians wrote: “Don’t do imaging for low back pain within the first six weeks, unless red flags are present.” And the American College of Cardiology said healthy patients don’t need to undergo cardiac stress imaging tests each year as part of their checkup routine. This kind of testing “rarely results in any meaningful change in patient management. This practice may, in fact, lead to unnecessary invasive procedures and excess radiation exposure without any proven impact on patients’ outcomes.”
“This isn’t a never-do list,” says Daniel Wolfson, executive vice president and chief operating officer of ABIM. “It’s a list of things that sometimes make sense for some patients, but are often inappropriately applied. The idea is for patients and physicians to have the information available so they can have honest conversations about their healthcare options.”
The Choosing Wisely initiative was just a year in the making, a tight deadline considering the scope of the project. Wolfson says most of the physician groups were eager to join in, and that some had been pondering how to tackle exactly this issue but weren’t sure about the best approach. Eight other physician groups, including the American Academy of Hospice and Palliative Medicine and the American College of Rheumatology, will join the initiative and contribute their own lists in the fall.
“These groups are really showing tremendous leadership,” says Wolfson.”What they’re saying is, there are some things out there that we need to question. Some of their members might push back.”
But it could be a big win for patients. Wolfson, who’s not an MD, blogged last year about an experience with his primary care doctor, who ordered an EKG when Wolfson had come to him complaining of a nagging cold. He wrote:
As a good and conscientious consumer, I questioned why. He replied that he needed to get a baseline test. Too sick and too tried to fight back, I reluctantly agreed to the test.
Since then I have learned that a baseline EKG yields little useful clinical information. In fact, the National Alliance of Physicians (NPA) … cites EKGs as tests that should be eliminated for asymptotic adults without a family history.
Wolfson continues about a friend who saw the same doctor and was administered a cardiac stress test because she’d just turned 60. The test came back inconclusive, so the doctor ordered a cardiac catheterization, a diagnostic procedure in which a catheter is inserted into a patient’s groin then fed up to the heart. The results came back normal, of course, but his friend was left with an aching leg and a skin rash.
“She was harmed and it was unnecessary,” he says. Wolfson hopes Choosing Wisely will help patients like his friend raise questions with doctors before undergoing such extreme measures.
To help get the word out, ABIM has partnered with Consumer Reports to compile the nine lists and develop a comprehensive guide that eliminates some of the medical jargon so patients can more easily understand the recommendations. The one-page guide will be distributed through the participating physician groups—with hopes that it’ll be made available to patients at doctors offices—as well as through consumer-oriented organizations such as AARP and SEIU to help expand the reach.
Boiled down to its logical conclusion, the obvious implication of Choosing Wisely is this: If doctors stop ordering unnecessary tests and treatments, it could make a serious dent in skyrocketing medical costs. Right?
“Costs are important and we know the current state of healthcare is not sustainable. But that wasn’t the driver for us,” says Wolfson. “What was more overriding was the notion that this is about quality of care, of better care. Its byproduct, secondarily, is the potential that there will be cost-savings. That’s a fringe benefit we’re happy to take.”