Choosing Wisely is a Great Idea. Does it Work?

If you don't know what Choosing Wisely is, start with our HCT episode on it. If you do, then still watch it. It's good.

I was a bit skeptical of its impact. So was I wrong? Is Choosing Wisely changing practice? Today we go to the research! This is Healthcare Triage News

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

And the housekeeping:

[paulpeterson]

Along the lines of making choices that do more good than harm, will the idea of not paying for things deemed "unnecessary" become an excuse for insurance companies who have their own profit motive to conclude that Expensive is synonymous with Unnecessary?" I'm all in favor of reducing unnecessary procedures; I'm even more in favor of getting profit motives out of health care.

[IkaraPentiki]

Please either make all annotations mobile as well, or put links for all annotations in the doobly-doo.

[kittykitty]

The problem with consumer driven choices is that your physician will not always know what your insurance company will/not cover. Not being able to wait 3 weeks for a "payment authorization" is a real concern for patients. I have personally fell victim to the "the doctor said you might want to do this" is not "by the request of the physician" and ended up paying >3k out of pocket because it was an elective procedure.

Making insurance companies have more readily available benefit summaries and explanations. Giving physicians an "at the moment" way to see what benefits are available for a person. These would be the first steps, not the last.

[ariannemaskey]

The issue with charging people out of pocket for getting tests that don't work is that most people will go with what the doctor says is best for them because they didn't go to medical school. They trust doctors. Then they find out after the fact that they didn't have to get the test and that their insurance wont cover it.

[Correctrix]

It would have been easy and helpful to simply give a brief definition of what you mean by "Choosing Wisely" at the beginning.

[MathAndComputers]

I'm pretty sure I've been prescribed real antibiotics as a placebo before. I had shooting eye pain a few days in a row, the optometrist found absolutely nothing, and still prescribed antiboitic eyedrops. (To his credit, he looked *very* thoroughly.) I walked out of there thinking "Damn, it's hit this low, has it?"

[savannahjh]

The timing of #7 interests me, & the increase of occurrence infuriates me, because my dad just spent 10 days in the hospital & won't be back at work for another 4 weeks (he's already missed 3) because of inflamed kidneys. Apparently they're not able to give a specific cause for this, but he has hypertension, & at his doctor's recommendation, has been taking the NSAID, Naproxen, everyday for years & everything he's been experiencing is a potential side effect.

[garrettkajmowicz]

What's the reason that NSAIDs shouldn't be used in people with hypertension?

[Chamelionroses]

Also problems with insurance companies...

[merrygaskill]

I did some googling (so, no real supported research).  The results I found said to use antibiotics for acute sinusitis.
I get acute sinusitis approx. 2x a year.  I've always been given antibiotics (including a kick-off shot) and have graduated to steroids, too.
What symptoms support that the infection is bacterial?

[SanthoshBoddu]

Why have you posted and deleted this video 3 times in a row?

[yenmano]

I really don't like the idea of making the patient act like a consumer (for non-Americans anyway). Are we going to ask physicians to spend time by billing patients why this service is not covered but this one is - and then explaining the evidence? I'm sure there is a way to streamline this.

One thing that has helped is that certain tests are just more difficult to get. A GP can't get a CT scan. Vitamin D must be written specifically (everyone is low Vitamin D) with a specific reason. I think that makes more sense as it puts the onus on physicians to give a good reason and maybe help re-think it.

I don't have any idea how to transfer that to rx though.

[kds]

Well - here in RI HPV vaccination is pretty much required for boys and girls. So that's one way to wipe the disease out.

[kristase]

Why do you always say JAMA instead of the Journal of the America Medical Association? Aren't these videos supposed to make research more, not less accessible? I have profs who always abbreviated their favourite journals when I was a research assistant, and it always felt like they just didn't care enough to make it make sense to me or they just wanted to sound smarter.

[Chamelionroses]

I think religion and culture doesn't only influence decision of patients, but doctors and other medical professionals as well.

[LyssandraNorton]

Hello Kitty! What have they done to you?

[itisdevonly]

Watched the referenced video first, and then it was glaringly obvious that you repeated much of the script from that one, word for word. That was kind of annoying.