Now comes the problem of provider and patient education.
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Now comes the problem of provider and patient education.Originally posted by Gruelius -
That's odd; Google News will link directly to it.
"Medical Societies List 45 Dubious Tests, Therapies
Robert Lowes
Authors and Disclosures
April 4, 2012 — A man sees a physician after a simple fainting spell — should he receive a brain imaging scan when there is no evidence of seizures or other neurological signs and symptoms?
The answer is no, according to a compendium of 45 clinical "don'ts" assembled by 9 medical societies for the sake of eliminating commonly ordered but often unnecessary tests and procedures. Such services, which are not rooted in evidence-based medicine, contribute to the high cost of healthcare and sometimes harm a patient's health, as in excessive radiation exposure in the course of diagnostic imaging or complications of a surgery after a false-positive test result.
The lists of questionable services (5 for each specialty) are part of a campaign organized by the American Board of Internal Medicine (ABIM) called Choosing Wisely. It builds on a similar ABIM project last year that identified 5 dubious tests and procedures for 3 specialties: internal medicine, family medicine, and pediatrics.
The 9 medical societies participating in Choosing Wisely are the American Academy of Allergy, Asthma, and Immunology (AAAAI); the American Academy of Family Physicians; the American College of Cardiology; the American College of Physicians (ACP); the American College of Radiology; the American Gastroenterological Association; the American Society of Clinical Oncology (ASCO); the American Society of Nephrology (ASN); and the American Society of Nuclear Cardiology.
"These societies have shown tremendous leadership in starting a long overdue and important conversation between physicians about what care is really needed," said ABIM President and Chief Executive Officer Christine Cassell, MD, in a news release.
The example of what not do to for a patient who fainted belongs to the list from the ACP. "In patients with witnessed syncope but with no suggestion of seizure and no report of other neurologic symptoms and signs," the ACP notes, "the likelihood of a central nervous system cause of the event is extremely low and patient outcomes are not improved with brain imaging studies."
The remaining ACP admonitions are as follows:
Do not order a stress test for asymptomatic patients who are at low risk for coronary heart disease.
Do not obtain imaging studies in patients with nonspecific low back pain.
Do not order imaging studies as an initial test for patients with low pretest probability of venous thromboembolism; instead, first obtain a high-sensitive D-dimer measurement.
Do not obtain a preoperative chest X-ray when lacking any clinical suspicion for intrathoracic pathology.
Diagnostic Imaging "Don'ts" Dominate
Not surprisingly, warnings against unnecessary diagnostic imaging also abound in the lists for the other specialties. ASCO, for example, cautions that physicians should not perform positron emission tomography, computed tomography, and radionuclide bone scans in the staging of early prostate cancer with a low risk for metastasis. ASCO explains that there is no evidence to suggest that such scans improve the detection of metastatic cancer or survival.
One item in the list from the AAAAI encourages, rather than discourages, testing. It advises physicians not to diagnose or manage asthma without spirometry. Basing the diagnosis merely on symptoms is problematic, because the symptoms may stem from causes other than asthma, according to the AAAAI.
Most of the 45 questionable services involve some form of testing. In contrast, 4 of the 5 "don'ts" compiled by the ASN alert physicians to treatment mistakes. One example is, "Avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure or chronic kidney disease from all causes, including diabetes." Another one from ASN is nontechnical in nature: "Don't initiate chronic dialysis without ensuring a shared decision-making process between patients, their families and their physicians."
Helping lead the Choose Wisely campaign is the watchdog organization Consumer Reports. It will work with other consumer-oriented groups such as AARP, the Leapfrog Group, and Wikipedia to educate patients about the lists of wasteful services. Presumably, an informed patient might question a physician's recommendation for a brain scan after a simple fainting spell. However, the Choosing Wisely campaign acknowledges that patients themselves often request unnecessary tests and treatments."Originally posted by GrueliusComment
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^ah yes I remember reading that. While it makes perfect sense, getting people/providers to use fewer treatments is an uphill battle. I hope it gains traction.Comment
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It's more about providing the correct treatments. Sometimes expensive/invasive diagnostic imaging is necessary and prudent. But yes, you're correct. The majority of the populace is overconfident in the "power" of medicine. Additionally, over 50% of of physicians in the US provide care in small, isolated practices. Logistically speaking, it's difficult to get most physicians on the same page and keep them all up to date.
The healthcare industry in the US is a $2.3T/yr enterprise. Providing the correct care 100% of the time will necessarily lead to decreased revenues across the board. I think that's a facet that people often overlook.Originally posted by GrueliusComment
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Nine prominent physician groups today released lists of 45 common tests and treatments they say are often unnecessary and may even harm patients.
The move represents a high-profile effort by physicians to help reduce the extraordinary amount of unnecessary treatment, said to account for as much as a third of the $2.6 trillion Americans spend on health care each year.Some numbers to put into perspective your similar previous post, at least based on this article."This could be a turning point if it's approached with energy," Berwick says. "Here you have scientifically grounded guidance from a number of major specialty societies addressing a very important problem, which is the overuse of ineffective care."Comment
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Good article about ACA and modern politics:
The irony is that the Democrats adopted it in the first place because they thought that it would help them secure conservative support. It had, after all, been at the heart of Republican health-care reforms for two decades.
The mandate made its political début in a 1989 Heritage Foundation brief titled “Assuring Affordable Health Care for All Americans,” as a counterpoint to the single-payer system and the employer mandate, which were favored in Democratic circles.It was not an isolated case. In 2007, both Newt Gingrich and John McCain wanted a cap-and-trade program in order to reduce carbon emissions. Today, neither they nor any other leading Republicans support cap-and-trade. In 2008, the Bush Administration proposed, pushed, and signed the Economic Stimulus Act, a deficit-financed tax cut designed to boost the flagging economy. Today, few Republicans admit that a deficit-financed stimulus can work. Indeed, with the exception of raising taxes on the rich, virtually every major policy currently associated with the Obama Administration was, within the past decade, a Republican idea in good standing.They’re told what the policy is, and their job is to find evidence and arguments that will justify the policy to the public.” For that reason, Haidt told me, “once group loyalties are engaged, you can’t change people’s minds by utterly refuting their arguments.But parties, though based on a set of principles, aren’t disinterested teachers in search of truth. They’re organized groups looking to increase their power. Or, as the psychologists would put it, their reasoning may be motivated by something other than accuracy.Certainly explains a lot of the news media and also political discussion - and why some people repeat party rhetoric rather than actually consider the facts / information at hand.As Senator Olympia Snowe, of Maine, who has announced that she is leaving the Senate because of the noxious political climate, says, “You can find a think tank to buttress any view or position, and then you can give it the aura of legitimacy and credibility by referring to their report.” And, as we’re increasingly able to choose our information sources based on their tendency to back up whatever we already believe, we don’t even have to hear the arguments from the other side, much less give them serious consideration. Partisans who may not have strong opinions on the underlying issues thus get a clear signal on what their party wants them to think, along with reams of information on why they should think it.
Not a good evolution of governance or society.Comment
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I actually read that article at the airport recently. Good read... and depressing.Good article about ACA and modern politics:
Certainly explains a lot of the news media and also political discussion - and why some people repeat party rhetoric rather than actually consider the facts / information at hand.
Not a good evolution of governance or society.
Good passage:
Psychologists have a term for this: “motivated reasoning,” which Dan Kahan, a professor of law and psychology at Yale, defines as “when a person is conforming their assessments of information to some interest or goal that is independent of accuracy”—an interest or goal such as remaining a well-regarded member of his political party, or winning the next election, or even just winning an argument.Originally posted by GrueliusComment
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Well it looks like the mandate is constitiutional 5-4, Roberts siding with the liberals. You don't have to have insurance but you would be required to pay the tax.
Maybe the title of this thread should be changed.sigpicComment
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^nice
In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.sigpicComment
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We're all subjects nowBuild your own dreams, or someone else will hire you to build theirs!
Your signature picture has been removed since it contained the Photobucket "upgrade your account" image.Comment
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romney just won the election thanks to scotus
if conservatives ever needed more incentive to go and vote, there it is
expect obama to rub it in the republican's faces, and then expect romney and a republican senate and house to dismantle it in year one“There is nothing government can give you that it hasn’t taken from you in the first place”
Sir Winston ChurchillComment
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and herb, i expect you to willingly buy a chevy or face a penalty, oops i mean tax, imposed by the new republican congress“There is nothing government can give you that it hasn’t taken from you in the first place”
Sir Winston ChurchillComment
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