Choosing Wisely and Encouraging Effective Treatment

Whenever I give a talk on the sorry state of the US health care system, someone asks me what we should do. My first comment is always something along the lines of "if we knew what to do, we'd have already done it". But if I'm pushed, I will usually note that the best first step would be for us to stop doing things that don't work.

There's an organization dedicated to that. It's called Choosing Wisely. It's also the topic of this week's Healthcare Triage.

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

[Bubbles-lpcv]

I am thoroughly pleased with the concept of "Choose Wisely" and support its efforts to increase the quality of effective treatment.

[MiriQLMovies]

When I go to see the doctor, I am prescribed or offered to buy medicine for every single symptom that I list to them. I've seen 3 different doctors and they all do the same thing. IF I have a fever and there's a known illness going around the city, they tell me to buy medicine X, but also medicine Z for headache and medicine Y for muscle pain... And I never buy anything else than medicine X. It helps, and all my other symptoms are gone with the fever. I live in Europe.

[imaytag]

Sometimes I miss your videos because the colours you choose for the thumbnails makes me think I've already watched it as I scan my subscriptions.

[Djiril]

2:56 made me wince a bit.  Maybe CT scans aren't necessary in most of those cases, but when I was 1 year old I got what the doctors thought was a minor head injury after an accident with a kid carrier.  The doctors told my parents that a CT scan wasn't necessary, but my mom got a "feeling" about my behavior and insisted.  What they found was that they needed to operate right away to keep me from dying (something about blood overtaking my brain, I think).  While I can understand where you're coming from, it's hard to listen to this knowing that I'm a statistical outlier and might be considered an acceptable loss under this model.

[kmjmw]

I agree that there are areas spending needs to be decreased. I see this being an extremely long process and deciding which tests and procedures should be done on certain patients as well as when to conduct them will be a major hurdle. Most of these tests and procedures are done as precautionary measures and even though many cases they are seen as unnecessary, there will always be cases it ends up benefiting the patient. There needs to be a set of guidelines for physicians to follow and stick with in all situations, especially when it comes to government spending.this doesn't mean that patients cannot receive these tests because they can still pay it out of pocket. I feel like this would save a lot of money and enable government health spending to be focused in other areas.

[RainAngel]

I really really agree with the statement about not inducing labor or performing a caesarean when not necessary. Such a waste of money, and there is so much potential for harm to baby and mother. Those are interventions that should only be made when necessary.

[LindyPenguin]

Just watched a news spot about Choosing Wisely being launched in Australia. Excellent news!

[kujmous]

Seriously need to tweet this entire channel to the President...  Excellent content.

[charlietuba]

When will the next Healthcare Triage LIVE be? I recall there was supposed to be one on April 8.

[ambrous]

How about pro con on high fructose corn syrup.

[tyrant-den]

what's your opinion adhd medication for children?

[AvielMenter]

"Financial incentives drive behaviour"; was there not a recent healthcare triage video finding that pay for performance resulted in little difference in treatment?

[dimbulb]

How much could be saved if hospitals didn't gouge patience and insurance for everything from surgery to a box of tissue?

[x-c-]

Would you do a show on out of hospital births with regard to health outcomes and costs?  Thanks!

[argella]

Especially with the antibiotics thing, doctors might be pressured by pharmaceutical companies to sell and prescribe certain drugs.

[HorzaPanda]

In my first year at university I was prescribed antibiotics for bronchitis, makes me wonder why the doctor did that ^^"

[emilyl]

The United States definitely needs to find ways to decrease their spending on health care. Especially since we are the country that spends the most of our budget on health care, yet we do not have the best healthcare system. This definitely is not going to happen over night, it is going to take a lot of time. I do not think the United States should go to universal health care because it would cause complete chaos and a lot of back and fourth arguments between political parties, however I do think they should make decisions on which tests/procedures should be done to patients. I feel this also would cause a lot of obstacles, but would be easier to achieve than universal healthcare. Instead of hospitals and doctors setting these policies, I think the government should. If the government regulates these policies there will be no confusion between hospitals, or between hospitals and insurance companies. If patients do not meet the guidelines, but still want a certain procedure done they should either pay out of pocket or be able to make a case to there insurance company stating why they need the procedure. I feel they should still be able to get procedures done if they can find a doctor who agrees that the procedure is safe or willing to do it because people still have the rights to there bodies.

[kavudx]

You are doing an extremely important job, unfortunately, it's exactly how you said, it's all about incentives. Doctors want to prescribe easy treatments that will make several patients happy, and satisfied. Doing a complex treatment on sinusitis or simply not treating it at all, would make a single doctor look like a fool while the other doctors offer "better", simpler and easier treatments. Unless this became an actual norm or got somehow regulated by law, this is hardly going to happen on it's own.

[scream]

If you want doctors to test and treat appropriately, then you need to remove them from legal liability if they use prudent medicine but there is still bad, even fatal, outcome.

[Cuddlesthemighty]

Why hasn't IBM Watson taken over yet. These useless tests would not be allowed by IBM Watson. Tests that matter like ones involving portals and companion cubes would be its focus.