The Choosing Wisely Campaign
...Could Too Much Care Be a Bad Thing?
On the surface, it would seem that more care is better care; however nothing could be farther from the truth.
Let me begin with a story that occurred yesterday - A relative of mine called panic stricken. She has had migraines for 30 years and just started with a new neurologist who recommended that she have an MRI of the brain, despite documented medical evidence that this is not necessary in patients with uncomplicated migraine. The MRI showed a small cyst in her brain that had likely been there her whole life, but was told this might need to come out. She was then referred to a neurosurgeon. She will spend the next several years seeing the neurosurgeon whose protocol will be serial MRI scans. Aside from the ongoing anxiety, she will now incur yearly costs in excess of $1,000 to follow an insignificant abnormality that does not require treatment.
It is estimated that one third of the healthcare delivered in this country, totaling $670 billion annually, is wasted care. This equates to over $2,000 annually for every person in the United States. Wasted care is defined as care that does not improve health outcomes or quality of life.
Too frequently, this care poses a danger when it leads to unnecessary surgeries such as numerous back operations, or invasive diagnostic tests such as unnecessary heart catheterizations.
How can we begin to bring value to our healthcare system?
In 2012, a joint venture of the American Board of Internal Medicine and Consumer Reports launched the Choosing Wisely, an initiative of ABIM. This bold venture challenged 40 medical specialty societies to each create a list of five tests or procedures that were over utilized and oftentimes unnecessary. These lists were created by physicians - not health plans or politicians.
How the various societies responded to the challenge spoke to how invested the societies and their physicians are to the elimination of wasted care in our healthcare system. Some societies, such as the American College of Medicine, went right to the heart of the issue with very valuable input such as not doing unnecessary MRI's of the back or brain, or cardiac stress tests. Others, such as the American Academy of Orthopedic Surgeons skirted the importance of this project by offering fairly meaningless suggestions such as, not using over the counter supplements for arthritis and not doing some rarely performed surgeries. They unfortunately missed the opportunity to talk about the unnecessary knee arthroscopies and joint replacements that occur.
The cost of health care in the United States is not affordable for many people or for the nation. The US spends more than 20 times what comparable countries spend on healthcare, but has lower health outcomes. Choosing Wisely is the beginning of a critical dialogue between patients and their physicians. The responsibility of improving the value of healthcare delivered in this country is a shared responsibility of both physicians and patients. The decisions made by physicians account for most of a patient's expenses. Physicians need to become accountable for delivering the right care, to the right patient, at the right time. Patients, for their part, can utilize the Choosing Wisely website to help manage their expectations when thinking about requesting a test or procedure. Together, we can help reshape the habitual patterns that have led to the overuse of healthcare.
It is important to be clear that this is not health care rationing. Remember we are talking only about the elimination of care that does not improve health outcomes or quality of life, and care that is potentially dangerous.
The solution to the health care crisis lies in the hands of physicians and patients, and we applaud the efforts of the Choosing Wisely initiative in taking this first major step forward.
Ken Cohen, MD, F.A.C.P
Evergreen Internal Medicine
Chief Medical Officer, New West Physicians