Doctors Improving Care by “Choosing Wisely” With Patients

Aug. 22, 2014

In an 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.

Having 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 to consider.

For 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.

“You 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.”

Dr. 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.

At TMA’s 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 Foundation.

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.

“Instead 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

Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320

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