"Patients should be involved in their medical care and understand why they are getting things and question it," said Meredith Reyes, MD.
The Houston pathologist is using Choosing Wisely to help educate patients and physicians on proper transfusion practices.
"With every unit you get, there is an increased risk of transfusion reactions," said Dr. Reyes.
The Choosing Wisely campaign, www.choosingwisely.org, promotes healthy dialogue between physicians and their patients. This physician-led movement, which commenced in 2012, 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 the Robert Wood Johnson Foundation to make physicians and the public more aware of the lists and to encourage their use.
Dr. Reyes says the Choosing Wisely initiative fits well with other specialized initiatives like patient blood management (PBM). Not only does PBM help decrease blood usage, but it also helps involve the patient in the decision to have a transfusion.
"A lot of doctors receive their transfusion training in a couple of hours in medical school, and their practice remains the same over years and decades," she said.
Part of Dr. Reyes' job is to review transfusions in hospitals and educate physicians on new guidelines and literature for blood transfusion practices. She focuses on educating doctors on changes in recent years to the transfusion thought process.
"We used to transfuse liberally, thinking that there was no harm that it was doing to the patient if it was done correctly, but recent literature has shown that that is not the case. We really don't know what we are doing to patients when we transfuse them," said Dr. Reyes.
Out of the five Choosing Wisely recommendations provided by the American Association of Blood Banks, Dr. Reyes finds the first one to be the most impactful: "Don't transfuse more units of blood than absolutely necessary."
"People aren't educated on recent guidelines and literature," said Dr. Reyes. "Old thinking was that patients should have a hemoglobin of 10 and hematocrit of 30 to be adequately oxygenized."
She says new studies show more restrictive practices have comparable and even better outcomes. "Patients can get down to a hemoglobin of 7 or 8 before you have to think about transfusion."
Dr. Reyes hopes patients and physicians will begin to have more conversations about transfusion practices before performing these procedures.
"Studies have shown that oftentimes you can reach a hemoglobin goal with just one unit," she says.
Dr. Reyes says she has seen many patients who are symptomatically better after only one unit. If physicians look at patients' symptoms along with lab results, Dr. Reyes is confident the patients will receive the care they need with good dialogue between patients and physicians.
To learn more about Choosing Wisely, please visit the TMA Choosing Wisely webpage at www.texmed.org/choosingwisely.
Texas Medicine, Dec. 2014