Too often, family members are left to make difficult decisions about care for a loved one who is at the end of his or her life. Emotions are running high and, without clear instructions from the patient, the family may make decisions about their care that goes against the patient’s wishes. It can be difficult to think about, but making decisions about care at the end of life before someone is seriously ill or incapacitated is important. The Conversation Project helps patients, families and healthcare providers discuss end-of-life care. The project provides a toolkit to help start these conversations and consolidate the patient’s wishes in one central location. It lays out medical terminology in easy-to-understand language and answers frequently asked questions about what end-of-life care options may be available. Click here to download the toolkit and share with patients.
By now, I suspect that you’ve caught on from your national societies that the initiative called Choosing Wisely is here to stay. We have been highlighting the program as well. Recently we welcomed Daniel Wolfson, MHSA, a leader from the ABIM Foundation, to the AAMC Board Committee on Quality and Patient Safety. He walked us through the evolution of the movement and its primary goals related to physician leadership and professionalism. Wolfson is a masterful communicator and blogger. Click here to check out his past blogs, including a recent entry about Atul Gawande’s article in the New Yorker.
I invite you to comment here about your thoughts related to Choosing Wisely.
SEMINAR: Reputation Management and Social Media Evolution for Medical Practices: Reactive, Proactive and Legal Implications
Educate and empower yourself to promote health education, health literacy and healthcare delivery and protect your online reputation. Free event by Maryland Physician. Register here or call Jackie Kinsella at 443.837.6948. Register today to win a free 16GB iPod Touch.
Medical staff member Paul W. Davies, MD, was sworn in on September 18 as Maryland’s first Chairman of the Medical Marijuana Commission. This marks a historic development in Maryland’s journey toward legalizing marijuana for medicinal purposes. Gov. Martin O’Malley named 11 people, including health professionals, lawyers, a police chief, and a prosecutor to a commission to oversee Maryland’s new law legalizing marijuana use for medical reasons.
The law limits distribution of cannabis to a small number of academic medical centers. The commission has the authority to permit the centers to design and implement programs that make marijuana available to defined groups of patients. The marijuana commission is scheduled to have its first meeting in Baltimore on September 24.
Dr. Davies is the founder and CEO of Kure Pain Management, is board-certified in both anesthesia and pain management. Dr. Davies was a post-doctoral fellow in pain management at Johns Hopkins School of Medicine. He earned his medical degree from the University of Manchester, England. He has trained at the University of Pittsburgh, Baylor College of Medicine in Houston, Albert Einstein Medical Center in Philadelphia and at the Johns Hopkins University Medical Center in Baltimore.
In an unprecedented public health initiative during an era of diminishing resources, 35 medical professional organizations have joined forces with consumer groups to promote safe and responsible utilization practices, i.e. Choosing Wisely, for both patients and physicians.
Each partner organization has created or will create a list of five medical tests, procedures or medication indications that are of low value and associated with causing harm. Examples include early use of imaging for low back pain (in the absence of red flags), routine pre-operative chest x-rays, antibiotics for acute sinusitis, and screening DEXA scans in subjects at low risk for osteoporosis. There are 45 such recommendations at present with more to come in 2013 as additional organizations join the campaign.
Recognizing that demand for low-value tests often originates from the public, the Choosing Wisely campaign has gained broad credibility in the lay media by partnering with prominent entities that enjoy loyal consumer following, including Consumer Reports and AARP. Cogent, patient-friendly information resources from Choosing Wisely can be used in your practice to help patients understand why more tests or more medications aren’t always the best plan.
The unambiguous statements by professional societies recommending against certain tests in certain situations set a clear “standard of care” that should provide a comfort level to physicians when having discussions with patients and families about tests of questionable value and potential harm.
The website ChoosingWisely.org contains links to each of the current 45 Choosing Wisely recommendations, and the evidence used to develop them. It also lists the professional societies that are due to create their lists in 2013. Patient resources, such as well-written one-page discussions of the recommendations, may also be downloaded from the site.