Choosing Wisely

According to the American Board of Internal Medicine Foundation, “Overuse, or care that has a greater potential for harm than benefit, is widespread in American medicine, with severe effects on both quality of care and health care costs.” For this reason, ten years ago this foundation initiated the Choosing Wisely campaign “…to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures.” The idea was to promote conversations between patients and clinicians. More than 80 specialty societies, such as the American College of Cardiology, have signed on. Together, they have created a list of more than 600 treatments that do not improve patients’ health.

Unfortunately, the campaign hasn’t been terribly successful. Unnecessary medical services continue to account for an estimated 10 to 20% of healthcare in the U.S., costing $75 billion to $101 billion a year. The lack of success is partly because doctors are uncomfortable with uncertainty, fear malpractice suits, and lack the time to counsel patients. More importantly, perhaps, patients prefer to get the tests and treatments. Surveys have shown that patients choose the procedures, as reported by one doctor, “…as a means to improve communication with their clinician.” In other words, more treatments give patients more opportunity to interact with their health care provider.

You can go to the Choosing Wisely website to see the lists of “low value” treatments and tests. For patients, a user-friendly page allows you to scroll through recommendations. Here’s a portion of one having to do with taking statin drugs to lower cholesterol: “…for older people, there is no clear evidence that high cholesterol leads to heart disease or death. In fact, some studies show the opposite—that older people with the lowest cholesterol levels actually have the highest risk of death.” Here’s one that has to do with annual checkups: “…healthy people often don’t need annual physicals, and they can even do more harm than good.” Of course, I choose the recommendations that agree with my opinions.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.