Aug. 22, 2013
era of scrutiny over medical costs, tests, prescriptions, and procedures,
physicians are sharpening an old diagnostic tool — conversation with patients.
Doctors are taking extra
steps to engage and inform patients to “take quality medical care to the next
level,” explains Texas Medicine
magazine, the Texas Medical Association’s (TMA’s)
official publication. “Hopefully future conversation will be the patient
asking, ‘Why are you doing this?’ and not, ‘Why AREN’T you doing this?’ ” said TMA
Council on Health Care Quality physician Gregory M. Fuller, MD.
discussions and redoubling efforts to think through specific problems and
solutions unique to each patient is the idea behind the new Choosing Wisely® campaign ─ it’s about
doing the right thing at the right time for the right patient, and avoiding
unnecessary care. The physician-driven initiative asked national specialty
societies to identify specific tests, procedures, or medications that are
common but may not be necessary at that time. More than 60 national medical
specialty societies have amassed more than 300 recommendations for physicians
example, patients often visit the doctor with respiratory symptoms and
immediately want the physician to prescribe antibiotics. But doctors know
antibiotics sometimes are not the correct solution to the problem, particularly
if they suspect the culprit is a viral infection. Patients who take antibiotics
too often can later become susceptible to nasty bugs that are resistant to
antibiotic treatments, and if it’s not the right solution, it’s a waste of
money. Yet in that situation the doctor must educate the patient about why what
he or she wants is not a beneficial solution.
In another example, many patients over age 50 have heard they need a
colonoscopy test, in which a specialist examines the patient’s colon with a
camera. Colorectal screenings have helped dramatically decrease colon cancer.
Yet does every patient whose doctor removed one or two colon polyps need repeat
follow-up tests more often than every five years? National experts in
gastroenterology now say some lower-risk patients might not need testing as
often as previously thought … and they included that in their Choosing Wisely recommendations.
would be surprised how receptive patients are when you tell them, ‘You don't
need to have a colonoscopy done,’ ” said Monte E. Troutman, DO, a Fort Worth
gastroenterologist. Patients want an explanation, he finds, and “then it
doesn't take much convincing.”
Troutman said it’s in patients’ best interest that physicians take time to talk
with patients and attempt the extra steps instead of defaulting to administering
another test. “Sometimes the best thing to do — and the hardest thing to do —
for the patient is nothing, other than offer advice. Put the pen and
prescription pad away,” he said.
annual conference in May, the association’s Council on Health Care Quality led
a continuing medical education seminar for physicians about the Choosing Wisely program, and will host
another panel at the upcoming TMA Fall Conference. TMA also has created
educational tools and videos to help physicians use Choosing Wisely to interact with patients so together they can achieve
better care. The ABIM Foundation awarded the association and its philanthropic
arm, the TMA Foundation, a grant to advance Choosing Wisely among Texas
physicians. Support for the grant program comes from the Robert Wood Johnson
One of the main reasons Choosing Wisely has attracted widespread participation is that the
campaign is physician-driven, says David H. Johnson, MD, a Dallas oncologist
who chairs the ABIM Board of Directors.
of third-party entities like insurance companies or Medicare saying, ‘Doctors
must do this or can’t do that,’ these are recommendations that physicians are
saying ‘we know by virtue of our daily practice and scientific literature that
these [treatments or tests] are of low value,’ ” Dr. Johnson said.
Choosing Wisely “is
really capturing an energy within the medical community to say in a more
constructive way, ‘We are the experts. We should help society decide what can
be reasonably avoided,’ versus just proscribing or prescribing,” Dr. Johnson
said. “After all, this is about our patients.”
TMA is the largest state medical
society in the nation, representing more than 47,000 physician and medical
student members. It is located in Austin and has 112 component county medical
societies around the state. TMA’s key objective since 1853 is to improve the
health of all Texans. TMA Foundation is the philanthropic arm of the
association and raises funds to support the public health and science priority
initiatives of TMA and the family of medicine.
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Contact: Pam Udall
phone: (512) 370-1382
cell: (512) 413-6807
phone: (512) 370-1381
cell: (512) 656-7320
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