Friday, August 22, 2014

Texas Physicians Practice Choosing Wisely: Part One

A Keller family physician is starting a conversation with his patients on antibiotic overuse.

In an era of scrutiny over medical costs, tests, prescriptions, and procedures, physicians are sharpening an old diagnostic tool — conversation with patients.

Doctors are taking extra steps to engage and inform patients to “take quality medical care to the next level,” explains Texas Medicine magazine, the Texas Medical Association’s (TMA’s) official publication. “Hopefully future conversation will be the patient asking, ‘Why are you doing this?’ and not, ‘Why AREN’T you doing this?’ ” said TMA Council on Health Care Quality physician Gregory M. Fuller, MD.

Having discussions and redoubling efforts to think through specific problems and solutions unique to each patient is the idea behind the new Choosing Wisely® campaign — it’s about doing the right thing at the right time for the right patient, and avoiding unnecessary care. The physician-driven initiative asked national specialty societies to identify specific tests, procedures, or medications that are common but may not be necessary at that time. More than 60 national medical specialty societies have amassed more than 300 recommendations for physicians to consider.

For Dr. Fuller, “choosing wisely” means engaging patients in discussions over their own care and educating them about why antibiotics or other treatments aren’t always the answer. Patients often visit the doctor with respiratory symptoms and immediately want the physician to prescribe antibiotics. But doctors know antibiotics sometimes are not the correct solution to the problem, particularly if they suspect the culprit is a viral infection. In that situation, Dr. Fuller says he educates the patient about why what he or she wants is not a beneficial solution.

That education starts with what Dr. Fuller describes as a “frank” conversation with his patients about side effects and antibiotic resistance, for example. He also uses the terms “virus” or “viral” frequently in conversation when explaining why prescribing the drug won’t make a difference with a viral infection and will end up wasting money.

“I try to teach my patients what is appropriate use of an antibiotic. Not why aren’t you prescribing an antibiotic, by why are you prescribing an antibiotic?”

The ABIM Foundation awarded the association and its philanthropic arm, the TMA Foundation, a grant to advance Choosing Wisely among Texas physicians. Support for the grant program comes from the Robert Wood Johnson Foundation. 

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