How a Morning Commute Led to Choosing Wisely
One morning in 2013, Jorge Plasencia, MD was listening to NPR on his way to work. Two words mentioned on air caught his attention—“choosing wisely.”
When Dr. Plasencia arrived at his office, a quick Google search took him to ChoosingWisely.org where he perused the Specialty Society Lists of Five Things Physicians and Patients Should Question as well as the patient-friendly brochures created by Consumer Reports.
“I thought, ‘this is something I need to be doing in my office,’” said Dr. Plasencia, who has run a solo family practice for eight years in Saginaw, Michigan.
Not long after that, he was having conversations about commonly overused tests and procedures with patients particularly around antibiotic overuse and CT scans for lower-back pain. Dr. Plasencia shared the Consumer Reports brochures with patients, encouraged them to review the materials and asked them to provide feedback on what they read. He often conducted follow-up conversations after the visit.
“Many patients use a patient portal, so I can communicate with them and send them a link to the Choosing Wisely® site,” he added.
Reactions varied by patient, Dr. Plasencia said. If one person came in with an expectation about a specific procedure, he or she might be disappointed to learn it is not recommended.
“That would be an option,” Dr. Plasencia recalled telling these patients. “But we want the best option in care. The discussion usually moved toward what might not be appropriate.”
He also reassured patients by pointing out the logo of the corresponding specialty society that accompanied the Choosing Wisely information, giving the materials added credibility.
“Specialists have concurred that this is the process we should be doing,” he said. “Over the years, physicians might not have been doing things that were completely evidence-based. Little by little, patients start to understand that this is not about keeping them from having the treatment. It’s about what’s best for them. That really resonates.”
Dr. Plasencia didn’t limit his Choosing Wisely conversations to patients. He discussed the initiative with his staff and with medical students doing clinical rotations in his office. He worked with the students to bring residents up-to-date with Choosing Wisely recommendations around common issues in family practice, including antibiotics, thyroid disease and acid reflux.
“Students picked a topic that they are really interested in and we put together a presentation around Choosing Wisely and shared it with residents,” Dr. Plasencia said. He even worked on a presentation with his daughter, who just finished medical school.
In addition to starting conversations about overuse, Dr. Plasencia took time to listen to concerns from fellow doctors. Many wonder how they can incorporate Choosing Wisely discussions into already too-short office visits. Dr. Plasencia said that simply sharing a link saves time.
During a recent presentation he gave to fellow doctors on patient portals and patient communications, he mentioned how he uses those methods to distribute Choosing Wisely materials. Dr. Plasencia is also looking to share links to the campaign with doctors and health care professionals through a regional physician-hospital organization’s newsletter.
“My hope is to spread the word about Choosing Wisely with a click of a button,” he said. “I want to use it every opportunity I can.”