A primary care doctor takes issue with Choosing Wisely

“You see, Dr. Oz was right, you’re ordering way too many tests for me,” a patient told me today after seeing news reports of today’s press conference in Washington DC by the Choosing Wisely campaign. This campaign, according to news reports (WSJPBSABCNBCNPR, AAFP, and others), points the finger directly at doctors for ordering “worthless” and unnecessary tests (that’s why the press, like patient advocates, love this story, because another opportunity to blame doctors). While I believe this is a noble cause, here are some of the issues that I have with it.

Where’s the patient responsibility? So, if I get this right, there is also going to be educational campaigns directed toward patients with slogans like, “Don’t expect that routine antibiotic for that cold,” or “Don’t expect routine testing if you’re asymtomatic.” There have been announced partnerships with consumer organizations like Consumer Reports Health, AARP, SEIU, and Wikipedia. Do you really think these groups will discourage patients from demanding unnecessary testing/treatments? Time will tell…

Thanks for making my job more difficult. With these reports today, patients are challenging me even harder about the testing and treatments that I am recommending. I don’t have a problem with this. However, I do have a problem how this story has been framed in that “I” am the reason why unnecessary tests are done, and my patients are more than happy to remind me of that.

Insurance companies must love this. Sometimes I really wonder if all these physician organizations really know how medicine is practiced at the grassroots by physicians like me. Every day, our office have staff members sit “on hold” for hours at at time trying to walk through the maze of preauthorizations for tests and medications. I really think this announcement will further embolden insurance companies (including Medicare/Medicaid) to raise the bar and make testing and treatment more difficult for me to adequately treat my patients.

Where’s the tort reform? Does anyone see that pink elephant in the room? Every time unnecessary tests are mentioned, physicians usually respond by saying things like “defensive medicine” and “fear of malpractice.” There have been many studies, arguably conflcting, asking the question about whether today’s medicolegal climate causes physicians to order tests that they maybe shouldn’t. I was disappointed that all these physician organizations had nothing to say about malpractice attorneys and the need for liabiility (meaning malpractice or tort) reform in this country. Everyone knows that it’s needed, but physician organizations are taking (in my opinion) the easy way out in blaming themselves and trying self reform first.

Here’s the dirty little secret. I’m a amateur pundit, but here’s what I think is really going on. All these physician organizations are afraid of the government (whether it’s Obamacare or other plan) ultimately deciding what tests should be done or not done. Private insurance companies are somewhat doing this now. So, if physicians can show that we can “police” ourselves, physician groups are hoping to score political points with those in Washington (that’s why the press conference was in DC today).

Now, don’t get me wrong. I agree with everything that happened today. 30 billion dollars annually of unnecessary tests are a real problem. However, will this effort really change the behavior of physicians? Probably not. Will this effort really try to educate patients not to ask for unnecessary tests? Probably not. Will this campaign hope to score political points with Congress and the White House? Some believe yes …

Mike Sevilla is a family physician who blogs at Family Medicine Rocks

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