Just like ‘too little care’, ‘too much care’ could also be detrimental to patients. Over the past few decades, the testing and treatment options in the medical education arena have increased manifold. The patients are being subjected to over-testing and over-treatment which is leading to consequences like unnecessary surgeries, physical sufferings, painful side effects and financial losses that impacts the household budgets severely.
Initiative to Prevent Waste and Risks in Healthcare
To prevent such waste and risks in the healthcare system, associated with unnecessary treatment, Choosing Wisely initiative has been introduced. The initiative urges the leading specialty societies and other organizations to identify medical tests and procedures in which the necessity should be questioned and consequences should be discussed with patients. Originally conceived and piloted by the National Physicians Alliance through an ABIM Foundation-funded Putting the Charter into Practice grant in 2009, the campaign has now spread to 18 countries and includes 75 partners that have published 490 recommendations.
A grant program is administered by the Foundation, also supported by the Robert Wood Johnson Foundation, to advance the campaign. The effort aims at bringing together health organizations from across the country to implement at least three Choosing Wisely recommendations. This also includes reducing antibiotics use for viral infections at hospitals and medical groups in their respective regions.
Efforts to Provide Appropriate Care
The inception of Choosing Wisely Medical Education has led to an evolution in the culture of medical education and the emphasis has shifted from thoroughness to appropriateness. In the year 2013, a set of “Choosing Wisely competencies” were developed by the collaboration of the ABIM Foundation and Costs of Care. The latter is a global nongovernmental organization that aims at making care better and affordable. Three general competencies were proposed by the group for all clinicians which include knowing “why”, “when” and “how” to choose wisely. Subsequently, interprofessional competencies with greater specificity were developed by the University of California–San Francisco Center for Healthcare Value. These competencies have been stratified according to the levels of expertise and have been used for creating multiple value-based healthcare curricular programs.
Bringing Affordability in Healthcare
Although there have been significant efforts for educating clinicians to choose wisely from the available treatment options, there still are certain challenges which create hindrance in assuring that the recommendations are affordable. In some cases, the care which is necessary could be expensive. Over the past decade, there has been a significant increase in the medical expenses for an average US worker. People are concerned about the risks and unexpected medical bills. On the other hand, clinicians are also unaware of how their decisions impact the patients financially. Often the clinicians have no idea about the legitimate options available which could limit the financial exposure for patients. Rare are the opportunities to optimize the health insurance coverage or develop payment plans.
This calls for additional efforts on the part of medical educators. There is a need of a framework for identifying patients at risk and either answering their question or referring patients to someone who can do so. Each patient might have unique needs and therefore clinicians need to work in collaboration with financial counselors, case managers, social workers and other inter-professional team members for optimizing plans for patients.
The good news is that, so far, medical education has been successful in bringing the essential transformation. Since long, the focus of clinical professions was on doing more, irrespective of the cost. Recently the focus has shifted to providing appropriate care, which has now become the professional norm, owing to the efforts of committed educators. However, there are still challenges that need to be overcome to prevent harm and educators need to play an important role in this to ensure that the system becomes affordable and easily navigable for patients.