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You’ve had a recurring headache for weeks; you’re convinced it’s a brain tumor. After popping ibuprofen by the handful, you decide to contact your doctor and insist on having him order an MRI.
Or you finally decide to have a doctor look at your aching back. After a thorough exam, he suggests a series of tests and procedures to determine a course of action.
These tests are cutting edge and expensive—but are they truly necessary?
HealthInsight Utah has received a grant from the ABIM Foundation to promote a “Choosing Wisely” campaign that encourages doctors and their patients to engage in conversations about what appropriate treatment really means. The initiative aims to give patients better information regarding their treatment options and encourages them to work with their caregivers to design a customized health-management plan.
Heidi Smith, HealthInsight’s Choosing Wisely project manager, says people need to take more responsibility for their own health and not blindly follow doctors’ orders without asking pertinent questions. By engaging in their own treatment, patients can make better choices, possibly eliminating unnecessary procedures.
“It’s not like taking the car to the mechanic, going to get a cup of coffee and coming back, and the car’s all fixed,” Smith says. “People need to be actively engaged in the process.”
Part of the problem is the country’s litigious attitude. No doctor wants to be the one who misses a cancer diagnosis or misreads the symptoms of a potentially life-threatening disease. So many doctors order tests to cover liability issues, leaving patients with growing medical costs—and more expensive insurance coverage.
Other times, the patient is the one pressing for the tests, since fear drives many medical decisions. But by creating a dialogue, doctors can convince patients to take a wait-and-see approach instead of diving into expensive, invasive or redundant procedures.
Right Test, Right Time
The Choosing Wisely program asks health organizations to pick five areas to target and create a list of medical tests they feel are overused or inappropriate. Since the national program’s inception in April 2012, more than 35 medical societies have contributed a list of procedures they believe should be seriously discussed between physicians and patients.
For example, the American Academy of Ophthalmology lists antibiotics for pink eye, imaging procedures and preoperative medical tests as part of its overused actions. And the American Society for Clinical Pathology created a mantra for its Choosing Wisely initiative that states, “Right test, right patient, right time at the right cost.” Some of the procedures addressed by the ASCP include population-based Vitamin D screenings, low-risk HPV testing and unnecessary annual pap tests for women over 30 with a history of negative results.
Brian Jackson serves as the vice president and chief medical informatics officer at Utah’s ARUP Laboratories. He’s a big proponent of the Choosing Wisely project and says it’s nicely aligned with the way his company thinks healthcare and medicine should be managed.
“American healthcare culture has the idea that more is better,” Jackson says. “As Americans, we’re very pro-technology, pro-innovation. The medical community has played into that and has colluded to do more and more testing to patients—and it might not be in the patients’ best interests.”
As hospitals, doctors and pharmaceutical companies tout the newest technologies and latest fast-fix, patients ask their physicians for these procedures in order to get what they believe will be the best diagnosis and the quickest remedy. But Jackson says only 10 percent of the clinical tests emerging today will stand the test of time. The rest will be ruled redundant—or even potentially harmful.
Proceed with Caution
Just as consumer awareness has educated patients about the dangers of overprescribed antibiotics, the Choosing Wisely project will empower people to ask questions, take charge and be more proactive in their healthcare.
“[Choosing Wisely] is a cultural campaign,” Jackson says. “It’s an education to counterbalance the technologic compulsions Americans embrace today. I think it will bring about a more conservative, cautious medical culture.”
With the majority of the country’s healthcare system based on a fee-for-service model, the more services a hospital or clinic provides, the more money it makes. When hospital beds are full, expensive diagnostic tools are being used and insurance companies have no natural incentive to reduce the use of medical services, patients end up with high healthcare bills and often unnecessary tests.