It seems a fairly basic concept: If the information provided by a diagnostic test is unlikely to change a patient's treatment plan, then physicians should think twice before ordering it.
It's the idea driving the American Board of Internal Medicine Foundation-led Choosing Wisely campaign in which nine specialty societies—representing about 375,000 physicians—have each identified five commonly ordered tests or procedures “for which the use should be re-evaluated by patients and clinicians,” wrote Dr. Christine Cassel, president and CEO of the ABIM Foundation, and James Guest, president and CEO of Consumer Reports, in an article published in the Journal of the American Medical Association.
The article notes that, with “looming government deficits,” there are areas of healthcare spending that do not contribute to the health of an individual patient or a collective community, but “the polarizing political environment makes it difficult to conduct rational public discussions about this issue.” While rational public discussion is desired, the ABIM Foundation is moving to avoid using another “R” word. “Rationing is where you withhold beneficial care—this is the opposite,” said Daniel Wolfson, ABIM Foundation executive vice president and chief operating officer, adding that the “five things” lists each specialty society has developed are not to be considered “never events,” but tools to be used only when the evidence suggests they will provide useful information or lead to a positive outcome. “What we're asking for is for people to have a conversation,” he added. “If we use our resources well, we'll have enough for everybody.”