Choosing Wisely continues conversation about unnecessary care

Categories: Community Engagement.

According to a report from the Institute of Medicine, up to 30% of healthcare delivered in the US is duplicative or unnecessary.

The Choosing Wisely campaign, first launched in April 2012 by the ABIM Foundation, aims to encourage physicians and patients to think and talk about what care is truly necessary for specific conditions. 

As part of the campaign, over the next few months, more than a dozen leading medical specialty societies will be publishing lists of specific tests or procedures that are commonly ordered but not always necessary, and could cause harm.

These new lists add to a growing library of more than 220 tests and procedures that have been identified as potentially harmful, and therefore may require further discussion between patients and physicians.

As a campaign partner, The American Academy of Hospice and Palliative Medicine published its list of “Five Things Physicians and Patients Should Question” last year. The list includes:

  • Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.
  • Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
  • Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.
  • Don’t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis.
  • Don’t use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) gel for nausea.

This list, along with a number of others, can be downloaded from the Choosing Wisely website, along with a number of patient-friendly resources, including:

  • Cancer care at the end of life: When to choose supportive care
  • Drugs to boost white blood cells for chemotherapy patients: When you need them…
  • Hard decisions about cancer

In addition to the new list, the ABIM Foundation is also working to educate physicians and help them develop their communication skills so they can have conversations with their patients about care. There is also ongoing work to publish easy-to-understand resources for patients to understand the recommendations from the campaign.

Richard J. Baron, MD, president and CEO of the ABIM Foundation, said: “The Choosing Wisely campaign calls on physicians to be the very best doctors they can be for their patients. While we’ve made progress in starting conversations aimed at avoiding overused tests and procedures, the release of new lists of things physicians and patients should talk about demonstrates there is still much work to be done.”

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