I’ve written several posts about Choosing Wisely, an initiative launched in 2012 by the American Board of Internal Medicine (ABIM) with the mission of decreasing the use of unnecessary health care.
Overuse of diagnostic tests, screening tests, surgeries and drugs is rampant in our health care culture, and it’s costing billions of dollars every year, not to mention that some patients are actually harmed by overtreatment.
It’s a noble goal, but the burden is on the consumer—the patient—to read and use Choosing Wisely’s lists of inappropriate treatments because a recent analysis shows that physicians are not paying enough attention to the initiative’s less-is-better message.
Aaron Carroll, MD, explains in a recent episode of Healthcare Triage:
Dr. Carroll sums up why he thinks Choosing Wisely is having so little impact among physicians:
Some doctors fear lawsuits, and Choosing Wisely won’t change that. Some doctors see a subset of patients that aren’t representative of the general population, and are conditioned to believe that more tests are necessary than really are. Choosing Wisely won’t change that, either. And yes, some doctors are influenced by financial incentives that subtly or overtly induce them to do more. Choosing Wisely certainly won’t change that.
Most of these efforts assume that we can change the behavior of physicians by willing them to do good. I wish that were true….We have to arm recommendations like these with teeth. Stop paying for stuff we know doesn’t work, or make people pay for it out of pocket.
I have to agree with Dr. Carroll’s cynical reality check. There is little incentive for physicians (or their hospital employers) to do less.
So it’s up to us, the patients, to be better informed. We can use Choosing Wisely to educate ourselves about which medical treatments might be unnecessary or harmful. We can use Choosing Wisely to create a list of questions to bring to our doctor(s) and help steer the discussion towards a fully-informed, effective treatment plan.
And we can use Choosing Wisely to let our health care providers know that we are serious about getting the best care, even if it’s the least care.
And more resources about overtreatment: