“Choosing Wisely is something that corroborates the best practices in medicine very well,” said Dr. Anuruddh Kumar (A.K.) Misra, MD, Medical Director at US HealthWorks in San Francisco, California. “It’s simple, it works well, and when it comes from the right source people are receptive to it.”
In recognition of his efforts to improve care in sports medicine, Dr. Misra was recently recognized as a Choosing Wisely Champion by the American Medical Society for Sports Medicine (AMSSM). Announced earlier this year, the Champions program is an initiative of the ABIM Foundation to recognize clinicians who are leading efforts to reduce overuse and waste in health care. More than a dozen leading medical specialty societies have committed to participate in the program.
“I think there’s so much information out there that physicians and patients don’t necessarily know where to go. One thing ABIM Foundation does well is that just the very words ‘Choosing Wisely’ resonate with people who want wisdom and direction,” he said.
Since launching in 2012, the Choosing Wisely® campaign has focused on encouraging clinicians and patients to engage in conversations about what care they may not need. Dr. Misra is among the early adopters of Choosing Wisely and incorporates these conversations into his daily practice. As part of his work, he regularly uses Consumer Reports’ Choosing Wisely materials to help educate patients on a one-on-one basis in his clinical practice. He says providing print-outs on topics such as antibiotics or MRIs supports discussions with his patients about care they won’t benefit from. Dr. Misra often circles key points and takes time to explain the pros and cons of an intervention to make sure patients fully understand why it won’t help them get better.
“Patients have a strong desire for information. What I try to convey is that if they’re looking for a particular opinion, they’ll find something online that will justify it. I ask them instead, ‘What are you in the office for?’ And then Choosing Wisely helps cut through all that other information so we can navigate to the point where we better understand what is needed for that patient to get the best care,” he said.
Dr. Misra says patients often have preconceived ideas of what care they need to get better. For example, a patient may ask for an MRI with the belief that it is a part of the treatment plan leading to reduced pain.
“They know it’s not an intervention, but you need to explain that an MRI is really to determine if they’re a surgical candidate or not. Once you can engage patients in that level of conversation, Choosing Wisely becomes very helpful. Because you can then look at those materials—which are so good—that if a person has pain in their leg you don’t go right to an MRI. You first try rehab for that person unless there are some other red flags,” he said.
Dr. Misra’s advice is in line with the AMSSM recommendation: “Avoid ordering a knee MRI for a patient with anterior knee pain without mechanical symptoms or effusion unless the patient has not improved following completion of an appropriate functional rehabilitation program.”
In addition to one-on-one conversations with his patients, Dr. Misra also cites Choosing Wisely regularly in multiple medical blogs to help educate the community at large. He says social media plays a critical role in spreading the Choosing Wisely message, helping stimulate interest nationally as well as internationally. His social media efforts have translated into regular radio and television interviews on topics such as concussions and computer vision syndrome.
Dr. Misra is a strong believer in Choosing Wisely’s ability to bring clarity to patients and help assuage their concerns. He also thinks that the campaign materials from specialty societies can be used to enhance clinician communication skills and build trust with patients.
“One thing patients don’t see is what’s happened to other patients in similar situations. So I let them know I’ve seen patients who have chosen to take the direction suggested by Choosing Wisely and they tend to do better. Once patients hear that I can share positive results of other patients like them, they want to have that too.”
Dr. Misra completed his Sports Medicine fellowship under the direction of Drs. Joshua Hackel and James Andrews at The Andrews Institute in Florida and is double board-certified in Sports and Internal Medicine. He is accessible via Twitter and LinkedIn, as well as via his website www.akmisramd.com.