Making Practice Guidelines And ‘Choosing Wisely’ More Effective

I always thought I was an informed patient, favoring conservative treatment and helping to save Medicare and the health system money; but when push came to shove, I was a coward that did not speak up when unnecessary tests were ordered. I think my reaction says something about the limits that even informed patients have in their ability to save the system money and ultimately raises questions about the usefulness of practice guidelines, “choosing wisely,” and evidence-based medicine to do the same. This isn’t an attack on these crucial efforts to bring more science to the practice of medicine. It is a plea for them to be more effective. As a personal example, when my eye doctor and I agreed it was time for cataract surgery, I signed up with a well-known, large-volume surgeon at his practice in Northern Virginia. In the middle of the elaborate, pricey process, I was given a pre- and post-surgical package. It included a form that required that before surgery the practice should receive a statement from my primary care physician with the results of a timely blood analysis and an EKG, even though I do not display any obvious morbidity warning signs—my blood pressure, BMI, and so forth are all very good. When I saw the form, I remembered—vaguely—that Cochrane and other advocates of evidence-based medicine had stated that most of the time those tests (and their costs) were not necessary pre-cataract surgery. But I didn’t say anything to the eye surgeon, de...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Medicare Quality Choosing Wisely practice guidelines Source Type: blogs