New Prescription for Better Health Care: Less is More

A groundbreaking campaign urges physicians to quit ordering 135 unnecessary tests and procedures

By Gary Drevitch
Originally Posted On May 30, 2013

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Gary Drevitch is senior Web editor for Next Avenue's Caregiving and Health & Well-Being channels. Follow Gary on Twitter @GaryDrevitch.

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When your physician recommends you undergo a battery of tests, even if you're not feeling ill, are you comforted or skeptical? Either way, most of us trust that our doctors are making the right decisions for our care and so, even if the tests seem onerous, we usually go along.

But now a new campaign seeks to empower patients and change that conversation. Choosing Wisely, launched in 2012 by the ABIM Foundation, has brought together the leaders of 26 physician societies representing more than 350,000 American doctors to do something many patients may find shocking: recommend that we get less medical care.

"It's an act of professionalism," says Daniel Wolfson, chief operating officer of the foundation. "Physicians groups are standing up to say here's the right thing to do in these circumstances. They've been quite courageous and bold."

Each participating physicians group has identified five common tests and procedures that may be overused, unnecessary or potentially harmful to patients. There are already 135 such guidelines posted on Choosing Wisely's website. By the end of the year, Wolfson expects to have more than 200 recommendations, from 40 doctors' groups. Another, patient-focused version of the list, using less technical language, can be found at consumerhealthchoices.org, a free site produced by the board's partner Consumer Reports, which also offers practical advice for raising questions with your physicians.

Family caregivers may find the guidelines especially informative. On its list, the American Geriatrics Society advises against using feeding tubes in patients with advanced dementia. Instead it prescribes that they be fed orally, to limit agitation, the use of restraints and pressure ulcers. And the American Academy of Hospice and Palliative Medicine discourages doctors from delaying palliative care techniques for seriously ill patients, even if they're already receiving aggressive treatment for their disease. The group's conclusion is based on evidence that the introduction of palliative care does not accelerate death, but relieves pain and limits overall costs.
 
Some recommendations may be controversial among some doctors and patients. For example, on its list, the American Society for Clinical Pathology advises against routine screening of low-risk patients for Vitamin D deficiency. The deficiency is common in many people, especially during winter months, the group says, and for most healthy patients, a combination of summer sun exposure and an over-the-counter supplement can satisfy Vitamin D requirements without the need for, or cost of, testing.

"This is all about cultural change," Wolfson says. "We want patients to go from asking, 'Why don't you do that test?' to 'Why did you do that test?' We are looking for those conversations to occur in the exam room at the local level. That's why we're doing this."