For the most part in geriatrics and palliative care we like to point the finger at other medical providers and say, “STOP.” Stop giving so much chemotherapy. Stop giving so many medications. Stop scanning.
But now it’s time to take a long hard look in the mirror.
Medical specialty organizations are being asked to come up with a list of 5 tests or treatments that are over-utilized or may actually be harmful. This effort, called the Choosing Wisely Initiative, is being spearheaded by the American Board of Internal Medicine (ABIM) Foundation. ABIM President and renowned geriatrician Christine Cassel was quoted in today’s New York Times saying:
“In fact, rationing is not necessary if you just don’t do the things that don’t help.”
This same articlenotes that as much as 1/3 of health care costs are wasted on unnecessary hospitalizations, tests, and treatments.
So far 9 specialty boards have come up with their lists – the boards and there list are here– but Geriatrics and Palliative Medicine are not one of the 9. Are we really “holier than thou?” I don’t think so.
I suspect we can come up with 5 tests or treatments for each specialty. It might be more fun to come up with lists for the cardiologists, oncologists, or surgeons, but that’s not the point. Ask not what another specialty should not be doing, but what you can do less of yourself.
It’s easier to come up with ideas if you don’t think of them as a hard and fast rules (never do x), but as a list of things doctors and patients should question routinely doing in geriatrics or palliative care.
So to jump start things, here are two from each field:
1. Screeningfor cancer in patients who are unlikely to benefit.
2. Insulinsliding scales
1. Using more expensive analgesics without evidence of superiority to less expensive alternatives
2. Using oxygeninstead of forced air
Let’s figure this out together. Or someone from another specialty may come up with our list for us!
by: Alex Smith