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Choosing Wisely. Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine. Choosing Wisely Campaign. Started by the ABIM Foundation in 2012 60 medical societies have joined

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Choosing Wisely

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Choosing wisely
Choosing Wisely

Kenneth Brummel-Smith, MD

Charlotte Edwards Maguire Professor of Geriatrics

Florida State University College of Medicine


Choosing wisely campaign
Choosing Wisely Campaign

  • Started by the ABIM Foundation in 2012

  • 60 medical societies have joined

  • List of 5 things (tests or treatments) that should not be done

    • Educate doctors – the medical societies

    • Educate patients – Consumer reports

  • https://www.youtube.com/watch?feature=player_embedded&v=bEYTnS7dCAg


Examples geriatrics
Examples - Geriatrics

  • Don’t use feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.

  • Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.

    • Healthy – 7.0%-7.5%, many conditions – 7.5%-8.0%, frail 8%-9%

  • Avoid using prescription appetite stimulants or high-calorie supplements for loss of appetite and weight loss in older adults;

    • Instead, optimize social supports, provide feeding assistance and clarify patient goals and expectations.


Examples long term care
Examples – Long Term Care

  • Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.

  • Don’t use sliding scale insulin for long-term diabetes management for individuals residing in the nursing home.

  • Don’t prescribe antipsychotic medications for behavioral and psychological symptoms of dementia in individuals with dementia without an assessment for an underlying cause of the behavior.

AMDA


Other examples miscellaneous
Other Examples -Miscellaneous

  • Don’t order sinus CTscans or indiscriminately prescribe antibiotics for uncomplicated sinusitis.

  • Don’t diagnose or manage asthma without spirometry.

  • Don’t do imaging (CT or MRI) for low back pain within the first six weeks, unless red flags are present.

  • Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms.


More examples
More examples

  • Don’t screen for carotid artery stenosis in asymptomatic adult patients.

  • Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

  • Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience.


A few more
A Few More

  • Don’t get a chest X-ray before surgery in the absence of a clinical suspicion for chest pathology.

  • Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.

  • Don’t perform neuroimaging studies in patients with stable migraine headaches.

  • Don’t prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for GI complications.


So what do you do
So – What Do You Do?

  • Whenever a treatment of a test is recommended, ASK:

    • What are the risks?

    • What are my options?

    • What will happen if I don’t do anything?

      • (get real numbers, not threats)


A revolution in health care
A Revolution in Health Care

  • Clinicians and patients working in partnership

  • Knowing the magnitude of the benefit of treatment

  • Knowing the potential harms – side effects, costs, inconvenience

  • Realizing that health decisions are YOUR decisions


Be an activated patient
Be An Activated Patient!

  • https://www.youtube.com/watch?feature=player_detailpage&v=FqQ-JuRDkl8


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