Choosing Wisely®: It is All About the Conversation

From our communications research, we’ve learned that one of the most difficult challenges physicians say they face in talking to their patients about why a test or procedure is not necessary or will not alter a treatment plan is they simply don’t have enough time during a regular office visit. They often say that if they don’t give a patient what they want, they leave the practice and end up getting the test or treatment anyway, from another doctor. Instead of being rewarded for talking a patient out of a service they won’t benefit from, they get penalized by losing a patient.

While there is a belief that patient-induced demand is a primary driver of overused tests or procedures, I do not know of any evidence that supports that claim. I suspect that certain tests and procedures that are often cited as being demanded by patients—like antibiotics and other tests like EKGs for preoperative surgery—are actually a function of the suppliers of care, the physicians and clinicians.

In April, nine specialty societies released lists of “Five Things Physicians and Patients Should Question” as part of the Choosing Wisely^® campaign. The goal of this effort is to promote physicians and patients to have conversations about what tests and procedures are truly necessary for their care. But if physicians cite time constraints as a barrier, how can we expect them to have these conversations?

That is why the ABIM Foundation recently partnered with the Drexel University College of Medicine to develop communication modules to hone the skills of practicing physicians, focusing on how to have conversations with patients about a test or procedure that is not beneficial and has the potential to cause harm.

The faculty at Drexel has a long track record teaching communication skills. On behalf of the American Academy on Communication in Healthcare, they created “Doc.Com”, a Web-based communication skills learning tool for training patient-physician communication that now houses more than 400 videos in a variety of communication skills topics.

To help put the Choosing Wisely recommendations in practice, Drexel staff will produce generic modules about communication skills, and collaborate with the specialty societies on topic-specific modules for specialists. Pre- and post-tests of communication skills and polls regarding attitudes about physicians’ role in managing finite resources will help assess their effectiveness.

The modules are expected to be complete in early 2013 and will reside on the websites of participating specialty societies. In fall 2012 additional specialty groups will release lists of “Five Things Physicians and Patients Should Question,” and new communications modules may be added in the future.

Avoiding unnecessary tests and procedures will require both patients and physicians to be informed about what care they truly need. Through Choosing Wisely, patients will be educated through easy-to-read materials from Consumer Reports.  Through the new communications modules, physicians will be better prepared and skilled about how to have these important conversations.

Choosing Wisely is all about the conversation, and now it can happen with informed patients and prepared physicians.  Let the conversations begin!

Daniel B. Wolfson
EVP and COO, ABIM Foundation