Monday, August 25, 2014

Texas Physicians Practice Choosing Wisely: Part Two

A Fort Worth physician is saving his patients from medically-unnecessary colonoscopies.

When Fort Worth gastroenterologist Monte E. Troutman, DO, first heard about Choosing Wisely®, it immediately changed his thinking.

“I’ve been a big advocate of colorectal cancer screening my whole career, and remarkably, over the past 10 years, we’ve seen a dramatic decrease in the incidence of colon cancer because of aggressive screening, most noticeably colonoscopy,” he told Texas Medicine magazine, the Texas Medical Association’s (TMA’s) official publication. “But there’s still about 45 percent of the population who should get screened and do not. And while a lot of people say we are doing a good job, unfortunately, we may be overdoing [screenings] for the people who are already adherent to the guidelines.”

The goal of the physician-driven Choosing Wisely campaign is to enhance quality and reduce waste by getting doctors and patients talking about medical tests and procedures that may be unnecessary ─ it’s about doing the right thing at the right time for the right patient. More than 60 national medical specialty societies have joined to identify more than 300 recommendations for physicians to consider.

For Dr. Troutman, “choosing wisely” means talking with his patients who are low-risk for colon cancer and explaining why they might not need colonoscopy testing as often as previously thought.
“You would be surprised how receptive patients are when you tell them, ‘You don't need to have a colonoscopy done,’ ” said Dr. Troutman. Patients want an explanation, he finds, and “then it doesn't take much convincing.”

Dr. Troutman said it’s in patients’ best interest that physicians take time to talk with patients and attempt the extra steps instead of defaulting to administering another test. “Sometimes the best thing to do — and the hardest thing to do — for the patient is nothing, other than offer advice. Put the pen and prescription pad away,” he said.

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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