News at NCH
"Choosing Healthcare Wisely" by Allen Weiss, MD, MBA, President & CEO

Choosing Healthcare Wisely

June 1st, 2013 - A major opportunity to improve the value of healthcare lies in eliminating unnecessary tests. This past February an initiative of the American Board of Internal Medicine (ABIM Foundation) issued a comprehensive report entitled Choosing Wisely. The focus of this broad and somewhat controversial report was on medical tests and procedures that may be unnecessary and, in some instances, can cause harm.

To spark conversations, leading medical specialty societies have created lists of “Things Physicians and Patients Should Question” — based on evidence so that recommendations could be discussed to help make wise decisions about the most appropriate care based on a patients’ individual situation.

Consumer Reports (Consumer's Report on Choosing Wisely) has developed and disseminated materials through large consumer groups to help patients engage their physicians in these conversations, and ask questions about what tests and procedures are right for them.

More than 35 specialty societies have now joined the campaign with some of the highlights pertinent to our demographics listed below.

  • Don’t do imaging (x-rays) for low back pain within six weeks of onset unless “red flags” are present – which is rare.

  • Don’t routinely prescribe antibiotics for mild to moderate upper respiratory infections (colds).

  • Don’t use DEXA screening which is a radiological measurement for osteoporosis in women younger than 65 or men younger than 70 with no risk factors and don’t perform these scans more often than every two years.

  • Don’t do EKGs or other cardiac screening for low risk patients without symptoms.

  • Don’t perform Pap smears on women younger than 21, who have had a hysterectomy for non-cancer disease, or older than 65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer. Women between 30 and 65 years of can be screened at three year intervals.

  • Don’t perform imaging of the carotid arteries for simple syncope (fainting) without other neurological symptoms.

  • Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks.

  • Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for a problem.

  • Don’t do imaging for uncomplicated headaches.

  • Don’t do computed tomography (CT) for the evaluation of suspected appendicitis in children, until after ultrasound has been considered as an option.

  • Don’t do preoperative or admission chest x-rays for ambulatory patients with unremarkable history and physicals.

  • Don’t perform MRI (magnetic resonance imaging) of the peripheral joints to routinely monitor inflammatory arthritis.

  • Don’t repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.

  • Don’t use sedative-hypnotics (sleeping pills) in older adults as a first choice for insomnia, agitation or delirium.

  • Don’t perform PET (positron-emission tomography), CT or nuclear bone scans in the staging of early prostate cancer or early breast cancer in patients with a low risk of the cancer spreading (metastasis).

The list goes on to over ninety “don’ts,” but equally important – and the message here – is what to do:

  • do communicate

  • do be involved and informed

  • do exercise

  • do watch your weight

… and be smart in order to enjoy a good quality of life. Healthcare is evolving faster now than ever; we know more and can do more. However, prudence matters and more is not always better.



 
Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.