Clare Hawkins, MD wants Texas physicians to use Choosing Wisely® to discuss geriatric tests or procedures.
"What families naively think is the right thing to do, often makes their family member worse," said Clare Hawkins, MD, of Legacy Community Health Services in Baytown.
This geriatrician recommends that his colleagues engage in conversations with their patients' family members to discuss common misconceptions of health care practices for the elderly. Dr. Hawkins uses Choosing Wisely® to educate family members who are making decisions for the well-being of their loved ones.
The Choosing Wisely campaign promotes healthy dialogue among physicians and their patients. Begun in 2012, this physician-led movement attempts to eliminate unnecessary tests and procedures predicated on evidence-based recommendations. These recommendations come from leading medical specialty societies that have identified the most salient issues patients should discuss with their physicians. TMA is working with the ABIM Foundation and Robert Wood Johnson Foundation to make physicians and the public more aware of the lists and encourage their use.
Of the 10 recommendations presented by the American Geriatric Society, Dr. Hawkins discussed the recommendation that patients with advanced dementia should receive oral-assisted feeding instead of a percutaneous feeding tube.
"The research shows that it doesn't reach any useful treatment for the patient who is suffering from advanced dementia," he said. "In fact, it makes them at a higher risk for both pressure ulcers and aspiration."
Dr. Hawkins says family members of hospitalized elderly patients worry the patients aren't getting enough nutrition.
"It is intuitive for family members to want to feed their aging relative," he said.
Yet Dr. Hawkins says a family member feeding the patient by hand is "counter culture" because common practice for patients with advanced dementia is to use a feeding tube. This creates an opportunity for the physician to suggest Choosing Wisely recommendations to discuss alternative care options with the patient's family.
Dr. Hawkins encourages other Texas geriatricians to engage in conversations that could lead to more helpful but counterintuitive practices.
For more information, visit the TMA website, www.texmed.org/choosingwisely.
Texas Medicine, Oct. 2014