Apr 13, 2012Science and Technology
Will guided conversations between patients and physicians lead to better outcomes?

The Choosing Wisely initiative is aiming to lessen unnecessary procedures.Evidence-based treatment for medical conditions is the goal of any health-care oriented operation, or at least it should be. Over the years, there has been a lot of concern about a lack of evidence-based treatments, and instead, an increase in what I like to call, patient-subscribed treatment. Current trends in pharmaceutical marketing generally target patients by suggesting they ask their doctor for a specific (and new) medication.  We’ve all seen the commercials saying, “Ask your doctor about…” 

When a patient comes to the doctor and asks for this new drug, chances are the pharmaceutical manufacture is providing an incentive for the doctors to prescribe their new medicines and/or treatments.  

For some time now, a new stereotype has made doctors seem like drug dealers looking to make a profit, rather than medical professionals interested in patient outcomes. As a result, unnecessary treatments and medications have been prescribed regardless of whether or not there is evidence supporting the decision. The newly-created initiative of the American Board of Internal Medicine Foundation, known as 'Choosing Wisely,' suggests there is evidence that doctors are not making decisions based on patient outcomes and aims to lessen unnecessary treatment . 

A couple weeks ago, I wrote about the relationship between higher spending and better patient outcomes. The bottom line was that in Canada, the relationship is a positive one -- higher spending is related to better outcomes; however, in the US, the relationship is less than positive -- high spending is not always associated with better outcomes for patients.  

Is this causing patients to take their health matters into their own hands and trust doctors less?

The Choosing Wisely initiative is designed to improve communication between patients and physicians; an admirable initiative, no doubt.  Let’s consider the typical trip to the doctor, in light of some items from Choosing Wisely's list of “five things physicians and patients should question,”created by the American Academy of Family Physicians. Do you agree with these recommendations?  

1 Low back pain.  According to the list, the fifth most common doctor visit is for low back pain.  If the complaint persists for less than six weeks without signs of neurological effects or osteomyelitis, the list cautions against imaging diagnostics because it results in higher spending only. 

2.Sinusitus. This is responsible for $5.8 billion in health-related costs each year, according to Choosing Wisely’s list. Using evidence-based reasoning, the only time sinusitis should be treated with an antibiotic is when signs of an infection (colored mucus and inflammation) are present.  Otherwise, this ailment is viral and will resolve without a prescription drug.  I find this interesting because I often get sinusitis and even though I lack both signs of an infection, the medicine I receive helps. Perhaps we have it in our head that the medication is fixing the problem when actually it’s not, which is what the evidence here suggested. 

3. Pap smears.  A common procedure considered to be vital to preventative health programs nationwide is now being recommended only for women over the age of 21. Shocking!  Pap smears are known to catch the signs of HPV infection, and possibly prevent cervical cancer in young women. In this situation, I must disagree with the cautionary words from Choosing Wisely because it’s better to air on the side of safety than to take an unnecessary health risk. 

The need for these cautionary lists from Choosing Wisely is a bit alarming, but I think it reflects a trend in people doubting their physician’s intentions. I am all for a solution that fosters effective communication about health care.  Perhaps this is what we need in order to rebuild trust between patients and physicians who share a common desire for a cost-efficient doctor visit.  On the other hand, maybe there is more to being a physician than practicing evidence-based medicine.  

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