“Without tort reform, Choosing Wisely are just empty words. Nobody is rewarded for ordering less.”
Explore This IssueACEP Now: Vol 35 – No 05 – May 2016
No argument from me. If we are asked by government agencies to reduce cost at the expense of diagnostic accuracy, we should expect professional liability protection or indemnification for doing so. However, I see Choosing Wisely differently. First, this is not a mandate from a federal or state agency. This initiative was generated from the medical community. Second, the goal, as defined by the American Board of Internal Medicine Foundation, isn’t specifically to reduce cost. According to the foundation’s website, “[Choosing Wisely] calls upon leading medical specialty societies and other organizations to identify tests or procedures commonly used in their field whose necessity should be questioned and discussed with patients.”
I’m not a champion for the Choosing Wisely campaign, but I do see value in its premise and the tools provided to guide us in meaningful discussions with our patients to avoid the use of low- to no-yield tests and procedures. I see more good than harm and even feel that incorporating these tools with shared decision making can be used to our advantage. Fewer tests equate to earlier dispositions and operational decompression of our EDs. Over-testing doesn’t improve diagnostic accuracy but increases cost and patient risk without added value. Choosing Wisely offers evidence-based recommendations, developed by emergency physicians for emergency physicians, which may serve as a basis for medical malpractice defense in the event that a bad outcome occurs from their adoption.
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