There seems to be a bit of press this month around patients having more to say about their medical care, as in the April edition of the New York Times, “Do Patients Want More Care or Less?” One of the key overall benefits of the Affordable Care Act is that millions of Americans who may not currently have any coverage at all can be insured. If the law works as planned many will have the opportunity to talk about needed medical tests and treatments with the doctors who serve them. Thanks to the internet, social media networks, and a new campaign – “Choosing Wisely” – many may come into these conversations with preconceived ideas of the care they need and even some skepticism about the services these doctors recommend.
Led by the American Board of Internal Medicine, “Choosing Wisely” aims to foster better dialogues between consumers and providers in conversations about which procedures are medically necessary. The campaign has united at least nine national medical associations, which include the American College of Cardiology and the American Academy of Family Physicians, to actually identify some of the common test s and procedures that warrant further discussion and question between the provider and the patient. Tests such as CT scans, cardiac workups and prescribing antibiotics for example, have all been noted as procedures or tests that should be up for discussion or question. There is even a list of 45 things doctors and patients should question and coming up later this month in Boston is an actual conference on “Avoiding Avoidable Care” that will convene physicians and other experts to discuss unnecessary medical care.
This consensus by some of the top tier societies is a move forward in my opinion. Dr. Christine K. Cassel, president and CEO of the ABIM Foundation, said in a written statement: “Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed.” “Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care.”
It would be wonderful if the “Choosing Wisely” campaign supports an open dialogue and encourages more providers not to take consumer questions as a personal affront. It may also lead to greater acknowledgement that some of the tests and procedures recommended and actually performed weren’t really necessary, which could lower medical spending. According to the New York Times article, some sources say that one-third of these expenditures in the U.S. are for unnecessary treatments.
As citizens of the U.S., we want access to the best, affordable care possible. Yet learning the pros and cons and side effects of potentially unnecessary procedures can still be daunting to the average consumer. Hopefully, medical school curriculum will include some guidance for future physicians who want to help patients through the process of making an informed decision. I’d also be interested to know what insurance companies have to say on this topic and am looking forward to skimming through a copy of “Overdiagnosed: Making People Sick in the Pursuit of Health” by H. Gilbert Welch, which should shed some light on how this new shift on consumer attitudes has come about. I also at least know now that the dynamic will not be so foreign to my provider should I so choose to question a recommendation.