After sharing our top reads from the summer, here are the top media and journal articles focusing on Choosing Wisely from the second half of 2017 and must-read stories for patients and physicians. Stay up-to-date by following @ABIMFoundation and #ChoosingWisely on Twitter.
NPR: Many Breast Cancer Patients Receive More Radiation Therapy Than Needed This in-depth report on overuse in breast cancer treatment includes perspectives from clinicians, researchers, experts and patients. One patient who received a long course of radiation when a shorter course might have been best for her said: “I would like to make sure that other women and men know this is an option.” The story notes that Choosing Wisely recommendations advise clinicians not to provide more radiation for cancer than necessary and to avoid screening for tumor markers after early breast cancer. “Patients used to feel like more is better,” said Daniel Wolfson, Executive Vice President of the ABIM Foundation. “But sometimes less is more. Changing that mindset is a major victory.”
Politico: Senior medicine: When ‘more’ isn’t better This story focuses on geriatricians as early champions of Choosing Wisely and quotes one physician as saying, “The cultural norm in geriatrics is that we are trying to do more with less. We try to protect our patients from some of the iatrogenic harms. We were the choir when Choosing Wisely came out.” It captures poignant moments between doctors and patients and reviews the campaign’s strengths (bottom-up approach, patient-centered, physician-driven) and challenges (physicians get paid when they perform tests and procedures, and many patients still believe “more is better”).
iMedicalApps: Choosing Wisely app: ABIM and Consumer Reports helps you make evidence-based decisions This publication caters to medical professionals, patients and analysts interested in mobile medical technology and rates different health care apps. After the Choosing Wisely app launched this summer, they gave it 4.5 stars out of 5. Reviewer Dr. Douglas Maurer wrote: “Finally, we have all of the Choosing Wisely recommendations in one place for providers to easily access on their mobile devices… I will certainly encourage my fellow providers, residents and fellows to use it and share the PDFs with patients.” Download the Choosing Wisely app for iPhone/iPad or Android to have 535 specialty society recommendations and 150 patient-friendly resources at your fingertips. The app was also listed among the best medical apps of 2017.
US News & World Report: Unnecessary Medicine: The Trump administration isn’t taking on the medical system’s culture of waste Dr. Andrew Parsons and Carolyn Engelhard wrote this opinion piece about how health care spending is projected to grow over the next decade and how health care waste and policies of the current administration could make the problem worse. They wrote: “Multiple physicians and medical organizations are working to challenge long-held beliefs about what constitutes value. Some examples include the Choosing Wisely campaign, initiated by the ABIM [Foundation] and now celebrating five years of success, which codifies low-value services and aims to promote dialogue between patients and doctors about unnecessary testing.” They also mention Costs of Care, the Society to Improve Diagnosis in Medicine and the High-Value Practice Academic Alliance as efforts that focus on reducing health care waste.
New York Times Well blog: With Cancer Screening, Better Safe Than Sorry? Columnist Jane Brody wrote: “Many patients, no matter how old or sick they may be, are reluctant to abandon tests they’ve long been told can be lifesaving.” She noted that in some cases, mammograms, PSA tests and colonoscopies have no benefit. The article cited a JAMA Internal Medicine research letter about a survey that showed women are more aware of the benefits of mammograms than the harms. Brody said that since insurance pays for the test and clinicians might be uncomfortable stopping cancer screenings, patients still receive unneeded screenings. She mentioned Choosing Wisely and also listed cancer screening guidelines from the United States Preventive Services Task Force.
For Physicians: (some articles may require registration or subscription)
Health Affairs: Choosing Wisely: How To Fulfill The Promise In The Next 5 Years The journal hosted a briefing in October to discuss the Choosing Wisely campaign at the five-year mark. Health Affairs also released several articles in conjunction with the event, including the results of a physician survey that showed no significant decrease in physician awareness of the campaign between 2014 and 2017. Drs. Eve Kerr, Jeffrey Kullgren and Sameer Saint discussed the campaign’s accomplishments in changing conversation and culture. They shared the innovations that the campaign can focus on in the next five years: identifying high-priority clinical targets, developing theory-based interventions, and evaluating interventions in ways that are clinically meaningful. Health Affairs also published two related blog posts, “The Transformation of Medical Education From Choosing More to Choosing Wisely” and “Professionalism and Choosing Wisely.”
PLOS ONE: Overtreatment in the United States Researchers from Johns Hopkins explore a survey of 2,106 physicians from an online AMA community on the topic of overutilization. They note that about 20 resident groups from the Departments of Surgery and Emergency Medicine have implemented quality improvement projects to address Choosing Wisely goals. The survey results indicated that physicians felt more than 20 percent of overall medical care was unnecessary, and many cited malpractice or profiting from procedures as reasons doctors provide care that might not be warranted. To address these issues, respondents suggested de-emphasizing fee-for-service physician compensation to reduce unnecessary and costly care.
AM Rounds (Academic Medicine blog): Creating Leadership Roles for Integrating Value into Academic Medical Programs Dr. Chris Moriates, a leader of efforts to teach value-based care at Dell Medical School at The University of Texas at Austin, helped launch the U.S. Choosing Wisely STARS (Students and Trainees for Resource Stewardship) program, which seeks to empower 50 medical students to lead Choosing Wisely efforts across 25 medical institutions around the country. “Developing a leadership role for creating programs that integrate value education and implementation is an emerging imperative for academic institutions,” he wrote.
Wall Street Journal: To Curb Unnecessary Care, Hospitals Use Physician Alerts This article focuses on how electronic alerts embedded in electronic medical records are prompting clinicians to provide evidence-based care. It notes that, “Lists used by electronic alerts to identify conditions under which certain steps in medical care could be considered unnecessary are maintained by doctors and health-care organizations. Medical societies around the U.S. contributed to a list first published in 2012 by the ABIM Foundation.” The story also features efforts related to Choosing Wisely at Cedars-Sinai Medical Center in California, Christus Health in Texas and Intermountain Healthcare in Utah that reduced unnecessary radiation from imaging and curbed prescriptions for opioids and antibiotics.
The Commonwealth Fund: Choosing Wisely: An International Campaign to Combat Overuse Drs. Karen Born and Wendy Levinson outline how Choosing Wisely has spread from the United States to about 20 countries around the world. They discuss how leaders from seven countries created 10 international Choosing Wisely recommendations, which include imaging for low back pain, antibiotics for sinusitis, benzodiazepines for older adults and pre-operative testing for routine surgery. They wrote: “Fostering measurement of overuse will help determine the impact of Choosing Wisely campaigns — and ultimately help reduce the harms from these potentially harmful and wasteful practices.”