It’s Not About The Box Improving Care at Group Health with People, Process and Technology

April 9, 2013

Choosing Wisely

Filed under: Uncategorized — Matt Handley @ 8:09 am

Several months ago Consumer reports put out a guide to cancer screening tests – and it was better than any summary I have read in a medical journal.  Plain language and pragmatic, it summarized the evidence simply, and remembered that the bar for a screening test is proof of improved health, rather than case finding, etc.  Consumer Reports has ben addressing overuse for about 5 years, well before ABIM started Choosing Wisely.

In a nutshell Choosing Wisely is about the identification of low value care.  I won’t go through the description of the program – their website does that well .  Now at 41 specialty societies.  There are now 135 Choosing Wisely topics – the most egregious causes of waste.  While some of us have been working on this idea for some time, many people do not know much about this, including many in academe.

John Santa MD MPH is the director of the Health Ratings Center for Consumer Reports.  He spoke today at a Puget Sound Health Alliance about the the possibility of transitioning Choosing Wisely from a campaign to a movement.    Social movements are a type of group action – they carry out, resist or undo social change.  He points out that consumers/patients have lost faith with healthcare, and conversations like the ones recommended through Choosing Wisely are one way to rebuild that trust.  Painful as it can be for them, more and more specialty societies are stepping up to participate.

Campaign to Movement:  the principles for communication about Choosing Wisely

  • Go where people are (e.g., wikipedia, vogue)
  • Talk about what they are talking about (usually benefits) and connect your dots to theirs (risk, waste)
  • Use safety if you can
  • Use empathic stories
  • Provide structure for decision-making (because consumers are wary of not following doctors advice)

I love the idea of engaging/mobilizing consumer groups to change medical practice.  While engaging clinicians is ideal, that work is easier if we have also gone directly to patients.  John Santa has been at the thin edge of the wedge dealing with groups that feel they have something to lose through participating, even if it is in the best interest of patients.  His stories remind me of how lucky I am to work in a place where one of the core competencies of our medical group is providing patient centered care and organizing around our patients instead of around doctors.

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