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Date: December 2012
Title: Choosing Wisely

The American Board of Internal Medicine (ABIM) started the project called Choosing Wisely. According to the ABIM foundation website: “Choosing Wisely is part of a multi-year effort of the ABIM Foundation to help physicians be better stewards of finite health care resources. Originally conceived and piloted by the National Physicians Alliance through a Putting the Charter into Practice grant, nine medical specialty organizations, along with Consumer Reports, have identified five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.”

Choosing Wisely partners include:

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians
  • American College of Cardiology
  • American College of Physicians
  • American College of Radiology
  • American Gastroenterological Association
  • American Society of Clinical Oncology
  • American Society of Nephrology
  • American Society of Nuclear Cardiology
  • National Physicians Alliance
ABIM challenged physicians and patients to start a conversation about what five things could be done to improve care. That included; doing things supported by the evidence, not duplicating other tests and procedures already done, choose care free from harm and only those that are truly necessary.
American College of Emergency Physicians:
ACEP decided for a variety of reasons NOT to participate in the Choose Wisely project. EP monthly did a PRO and CON debate this fall on the topic. Here are a few links for you to explore:
Some of the reasons suggested for ACEP not to participate:
  • Legal Liability
  • Goal of saving money conflicts with best care
  • Other specialties telling emergency physicians what to do or not do
  • Insurance companies may use the list as a reason to deny payment
South Huron Hospital: It is known as “Little Hospital that Does”...Choose Wisely.

We are a small rural facility which has 19 in-patient beds, 5 ED beds, and ~10,000 ED visits/year. Our medical staff decided on five things we could choose wisely to improve patient care based on the evidence.
        1. Influenza shots for staff with privileges
        2. Use Ottawa ankle and knee rules (clinical decision instruments)
        3. No routine use of antivirals for Bell’s Palsy
        4. No routine use of antibiotics for simple cutaneous abscesses
        5. No routine use of proton pump inhibitors for upper GI bleeds.
TheSGEM Challenge: Can you locally find five things your group could to and agree upon? A grass roots Choosing Wisely initiative. Please send me your suggestions to TheSGEM@gmail.com with Choosing Wisely in the subject line. I will not identify you but may compile a list for a future show.
TheSGEM Book Club: There are a few books out recently that discuss the over-diagnosis/over-treatment subject. Click on the “Additional Resource” tab and scroll down to the books. You will find one called Over Treated: Why too much medicine is making us sicker and poorer. The other book is called Over Diagnosed: Making people sick in the pursuit of health. If you know of any good books don’t by shy to send me an email.
Keener Kontest Winner: Chris Byrne from Western University in London, Ontario, Canada. He correctly identified our former Prime Minister (not a president) Jean Chrétien who had Bell’s Palsy and did not completely recover. The bonus question was Mr. Spock who can lift up his eyebrow only on one side when saying…fascinating.

 

Keener Kontest: You need to listen to the show this week to find out the question. Email your answer to TheSGEM@gmail.com or go to the “Contact Us” link at the top of the home page. Use “Keener Kontest” in the subject line. First one to email me the correct answer will win a cool skeptical prize:)

If you do not choose wisely we might end up like this guy in the Indiana Jones Movie “he chose…poorly”. We want to choose wisely and cut the KT window to < 1 year by registering for SkiBEEM 2013 Feb 4-6 at SilverStar BC.