10 Mar, 14 | by rradecki
In the United Kingdom, the NHS and Manchester publish “Choose Well” – a guide for patients in need, to help them find the healthcare resources correct for them. The resources described include self-care, local general practitioner services, and advice regarding when to choose Urgent Care or Accident & Emergency services. In a system where resources are understood to be finite, in order for all to have access to a reasonable level of healthcare, this is a prudent consumer-oriented approach.
The United States has a similarly-named system of choice – “Choosing Wisely”. Published by the American Board of Internal Medicine Foundation, this initiative also focuses on making choices in healthcare. However, rather than focusing primarily on helping patients make better choices, the true target of this initiative is an entirely different problem beguiling U.S. healthcare: physicians behaving badly. These initial lists, containing 5 or more items each, describe diagnostic tests and treatment modalities that ought to be re-examined – essentially, low-value candidates for expensive, harmful overuse that go further towards fattening physician and executive wallets, while providing uncertain patient-oriented benefit.
For Emergency Medicine in the U.S., the published list is prudent medicine – but hardly reflects the most costly & wasteful utilization of resources. Several prominent academics and educators have critiqued this list informally, while others have systematically attempted to derive their own. The important independent recommendations range from decreasing CT utilization, to mitigating over testing of low-risk chest pain, to avoiding costly hemostatic medications without clear indications.
Regardless, the point of distinction is clear – Choosing Well vs. Choosing Wisely. Patients ought to be expected to benefit from educational programs to help improve their decision-making. Physicians ought to be making high-value decisions every day – and we should be embarrassed our choices are so poor at baseline that an initiative such as Choosing Wisely even exists.