The Choosing Wisely campaign, an ABIM Foundation initiative, has brought together nine national physician organizations to create a list of “Five Things Physicians and Patients Should Question.” The tagline, however, is not referring to that mole your patient has had since birth that has conspicuously grown larger and sprouted hair. It’s actually referring to the test you are going to order to gather information about said mole. Essentially, the Choosing Wisely campaign is asking, “Is it really necessary?”
While the nation is asking itself why healthcare costs so much in the United States, it is simultaneously answering those questions and devising ways to reduce its costs. Population health initiatives aim at keeping people healthy and away from hospitals in the first place and home healthcare organizations treat people who are well enough to go home but still need continued monitoring. This leaves hospital beds open for those in dire states and studies have proven that patients heal better in comforting settings, like their own homes, and surrounded by family.
Now, the Choosing Wisely campaign is asking patients and physicians to consider another cost-saving technique –keep the tests to a minimum. Well, not exactly a minimum, but canceling out the unneccesary ones that have become a religious routine such as ordering annual EKGs or any other cardiac screening for low-risk patients who show no symptoms of cardiac trouble.
For those who feared the government was going to begin rationing care, the suggestion of cutting back on testing may seem like their worst fears are coming to pass. I’ll admit that the concept even makes me cringe a bit because, after all, when it comes to health what you don’t know can kill you.
But it turns out physicians have already admitted to the medical professions’ predisposition to over-ordering tests. In 2010, Carey Goldberg listed the “Top 10 Reasons Doctors Over Order.” The comments came flooding in and readers offered their own suggestions, growing the list to the “Top 10 Now Top 16 Reasons Doctors Over Order. The list includes things such as ordering tests based on routine rather than actual symptoms or pandering to patients out of fear of malpractice suits. Whatever the reason, The New York Times reported that up to one-third of the $2 trillion of annual healthcare costs in the United States each year is spent on unnecessary hospitalizations and tests, unproven treatments, ineffective new drugs and medical devices, and futile care at the end of life.
The only efficient way to cut cost is to cut waste. Many will argue whether reducing medical tests is the most prudent way to do that, however. On that top 10 list, in fact, one reason for over-ordering is because physicians believe you shouldn’t put a price on care. It’s an honorable explanation coming from an honorable profession. Unfortunately, the price is already there; the nation has just simply ignored it, except for insurers, of course. Now a campaign (backed by several physician organizations) has come along and asked us to make a choice.