When you need medical care, choosing wisely can be difficult.
First you must worry about choosing the right treatment. Is the treatment you are opting for the best available choice under the circumstances? Is it too aggressive? More medical interventions means more opportunities for side effects and complications. Or is it not aggressive enough? There aren’t always obvious answers to these questions.
Then you have to be concerned about cost. Will insurance cover it? How much deductible do you have to cover? And even if the cost isn’t coming out of your own wallet, you worry about contributing to excessive healthcare spending. In the U.S., we spend almost 20 percent of our GDP on healthcare, and up to one trillion dollars of that is for unnecessary treatments. We all have to consider the role we play in this issue.
Finally, you fear that you aren’t in the best frame-of-mind for complicated decision-making. The options can be hard to understand. Pain or fear of the future can be obstacles to objectivity. The pressure of the decision adds to the stress of being ill.
This all adds up to one thing – choosing between competing medical tests and treatments (or none at all) isn’t a straightforward situation.
The American Board of Internal Medicine (ABIM) Foundation recognized this issue. In response, they partnered with Consumer Reports and created a tool to help healthcare providers and consumers alike make better, more evidence-based decisions. The tool is called Choosing Wisely, and it offers suggestions for conversations patients and physicians should have about their diagnosis and treatment options.
The tool is organized into lists by topic. For example, if you suffer from back pain, you would refer to the Back Pain Tests and Treatments list. There you would get a quick overview on what the current medical evidence suggests about imaging tests like MRIs and CT scan, the usefulness of EMG and steroid injections, and the role of bed rest and pain killers for lower back pain.
Or if you are about to have surgery, you would look at the Medical Tests Before Surgery list. This explains the role of things like breathing tests and cardiac stress tests before surgery.
It is important to note that these lists are not designed to be the final word or make the decisions for you. They are meant to give you the tools you need to discuss your options with your doctor. Your doctor may have a very good reason for ordering a treatment that doesn’t make sense to you. These lists help you ask the questions so you can understand your physician’s thinking. The goal is to make the most informed choices possible.
Of course, no one wants to be faced with these decisions. The best way to avoid them is to stay healthy to begin with. Eat a varied diet rich in fruits and vegetables. Get a reasonable amount of exercise and plenty of sleep. Keep your stress under control. Get the preventive medical care you need – like the flu shot – to keep disease at bay. If you want some advice and coaching on staying healthy, the doctors at Hunt Regional Medical Partners would like to help. Get in touch to make an appointment. Remember, choosing wisely works best before you get sick.