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Be Well

Be Well: Choosing Wisely

Monday, September 30, 2013 at 8:00 PM

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Dr. Donald Ford, family medicine at the Cleveland Clinic

Amidst all the debate about healthcare in America are a couple of undeniable facts: We spend at least twice as much per capita as almost any other country; and countries that spend a lot less often have better health outcomes. One of the latest national efforts to address costs and benefits of medical treatments comes to Cleveland later this week. ideastream health Reporter Sarah Jane Tribble is here to tell us about it.

The director of Consumer Reports Health Ratings Center will be in Cleveland Thursday as part of an education campaign aimed at patients and healthcare providers.

Consumer Reports has joined with the American Board of Internal Medicine in an effort to get consumers and doctors engaged in conversations about unnecessary medical care. Working with a local group called Better Health Greater Cleveland, this national effort is all about choosing health care more wisely, that is, choosing tests and treatments that are most likely to actually benefit patients and avoiding those that could cause harm or are of limited value. 

The initiative being launched this Thursday in Cleveland is called “Choosing Wisely.”

The goal is to motivate patients to ask questions and have a conversation with their doctor to make sure they are getting the right care. And it’s encouraging healthcare professionals to stick to procedures that have been tested rigorously and proven to be effective.

Dr. Donald Ford, one of the Cleveland Clinic physicians who’s involved with this campaign to change the healthcare culture, says the goal is to be “very, very” thoughtful about whether to do a test or a procedure. 

“This is part of the age of modern medicine that we have to deal with. We have all this technology that can show us all this stuff but what you have to do is really think carefully about whether that is going to help get you better or not,” Ford says.

So, what kinds of procedures or tests is “ Choosing Wisely” targeting?

Nationally, Choosing Wisely has dozens of specialty organizations offering patients advice on anything from when to get an allergy test, when you need a colonoscopy or when you need a bone density test.

Now, the practice of medicine is science but it’s also an art; it’s not always 100% clear what treatment is best or whether to just “wait and see” when a lump shows up on your body.

There’s a very funny writer - David Sedaris - who had something to say about this awhile back.  We sometimes hear him on NPR.  In one of his more recent essays he related an experience he had with healthcare in France when a lump showed up near his chest.  Here’s a clip from that. 

“It was like a deviled egg tucked beneath my skin. Cancer. I thought. A phone call and 20 minutes later I was stretched out on the examining table with my shirt raised. Oh that’s nothing, the doctor said. A little fatty tumor. Dogs get them all the time. I thought of other things dogs have that I don’t want. Dew claws for example. Hook worms. Can I have it removed? I guess so, but why would you even want to? He made me feel vain and frivolous for even thinking about it.,” Sedaris says. 


In Sedaris’s case, the doctor did nothing.  No tests or x-rays. And everything was fine.

It’s interesting to note here that an international economic group reported this summer that health care spending in France averages $3,268 per person. In America , that spending is more than double: $8,223 annually.

But what if it had turned out to be something?

That’s the question that gets to the heart of medical decision-making in America.

For years, we’ve tilted far in the direction of defensive medicine and what often proves to be unnecessary tests.  Now we’re facing the realities of limited resources and the challenges of “Choosing Wisely.”

Obviously there’s much more to say on the subject and listeners can weigh in this Thursday on the Sound of Ideas when we’ll further explore what’s driving medical costs and how to deal with it. 

Additional Information

To learn more about Choosing Wisely, click here.

A recent article in JAMA Internal Medicine discusses the challenge of telling patients and doctors to be more careful about choosing care. ”Overuse of Health Care Services: When Less is More...More or Less.”

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