Choosing Wisely Champion Takes the Time to Talk About Risks
“I think what most physicians feel is most important – especially geriatricians – is to try and improve the quality of care we deliver to our older patients,” said Eric Anthony Lee, MD, a board certified internist who is Chief of General Internal Medicine at Kaiser Permanente West Los Angeles and the third Choosing Wisely Champion from the American Geriatrics Society (AGS).
The Champions program is an initiative to recognize clinicians who are leading efforts to reduce potentially unneeded and harmful tests and treatments. Dr. Lee joins more than 40 other clinicians who have been recognized as Choosing Wisely Champions.
As co-chair of the High Risk Drugs in the Elderly Committee for Kaiser Permanente, Southern California, Dr. Lee is a recognized authority on appropriate prescribing for older men and women.
“Often patients will ask for medications for very understandable reasons. Maybe they saw an ad on TV for a miracle sleeping aid. Or, they’ve heard from friends about antipsychotics to help patients with dementia. But we know those aren’t always appropriate for patients – particularly those at risk for functional decline or frailty,” he said. “I am responsible for communicating the rationale behind appropriate prescribing for physicians working within the Kaiser Permanente system in Southern California, so I educate my colleagues on which medications might lead to more harm than good, reminding them that we don’t always need to reflexively give medications for certain concerns.”
Dr. Lee said that in addition to giving lectures to his colleagues throughout Southern California, a lot of his work focuses on setting and communicating expectations to patients and their family members.
“If one takes the time to let patients and their families know about the risks of the medications – such as that antipsychotics can be harmful – and to also let them know about the literature behind efficacy and safety of medications, we can typically reduce their use,” he said. “But this can sometimes be difficult when families are desperate because their loved one is not doing well.”
In addition to his work involving medication safety, Dr. Lee also helped update Kaiser Permanente’s diabetes hemoglobin A1c reference range to be age-appropriate and developed delirium-prevention protocols. His research related to glycemic control for patients with diabetes aligns with the AGS’ Choosing Wisely recommendation to avoid medications other than metformin to achieve hemoglobin A1c less than 7.5% for most patients, instead aiming for moderate control.
“Physicians have been very supportive of Choosing Wisely because sometimes we feel like we’re overprescribing, and we do it because we think that’s what the patient or their family wants. But most of us realize sometimes these medications are given reflexively versus having true data,” he said. “Permanente physicians quote the Choosing Wisely campaign all the time. We’re really here to give the most appropriate care.”