Thursday, April 5, 2012

Choosing Wisely, Unnecessary Testing and the Simplistic Use of Web 1.0 to Attempt Physician and Patient Behavior Change

The Model T
There are certain Disease Management Care Blog behaviors that the spouse finds.... objectionable.  She has verbally educated the DMCB about them and has left written notes about them.  Since these communications haven't worked all that well, are there any other "channels" she could use? 

The DMCB spouse may be tempted to use the approach of the Choosing Wisely web-site. It provides lists of widely used medical tests and treatments that are typically unnecessary.  The lists (located here) were compiled as part of a joint physician and education project by organizations such as the American College of Cardiology (don't do stress tests in patients without cardiac symptoms) and the American College of Physicians (don't get back x-rays if the ache is non-specific). According to the press reports heralding the availability of this just opened web-site (for example), its purpose is to prompt patients and physicians "to work together" to not only make clinically wise choices, but save the U.S. health care system a lot of money.

The DMCB knows that the academic experts and organizations that developed these lists have been talking and writing about these wasteful tests and treatments for decades.  Waste has been the subject of infinite numbers of continuing education programs, grand rounds, published review articles, national meetings and guidelines.

Those approaches haven't worked. 

So is the fix is to repackage the information and post it as simple text on a web page?

The DMCB can't say it's impressed.  While the evidence underlying the clinical recommendations themselves is superb, there isn't any evidence that internet-based physician instruction is any better than traditional methods.  And if the purpose of the Choosing Widely web site is to prompt patient behavior change, the evidence that web-based education is better than print is pretty skinny there too

It's ironic that the intellectual rigor of the lists themselves wasn't matched by the same evidence-based approach to using the internet for this exercise in the first place.

What's more, if these groups insisted on using the internet, the least they could have done was deploy a Web 2.0 approach.  The current Choosing Wisely site is so.... has been

That being said, there is some information that could be of use to the population health management service providers.  In contrast to the physician organizations, the DMCB is confident that they'll know how to package and present the information so that it can have a real impact.

The DMCB wishes Choosing Wisely good luck.  And in the meantime, it looks like the DMCB spouse will have to continue to rely on verbal and written feedback.... for now.   

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