This month, AMA Journal of Ethics editor-in-chief Audiey Kao, MD, PhD, interviewed Wendy Levinson, MD, about the efforts of the Choosing Wisely initiative to foster cultural change in medicine cross-nationally by stimulating dialogue about overuse of tests and treatments
Although not everything on the Choosing Wisely lists is likely to reduce low-value care, it is a good starting point for a conversation about curtailing low-value interventions.
When ventilator support is being withdrawn from a dying child, responsive titration of sedative medications by the ICU team can relieve suffering without anesthetizing the child completely or hastening death.
David S. Gierada, MD and Lawrence M. Kotner, Jr., MD
Despite strong supportive evidence on and professional society endorsement of CT screening for lung cancer, there is minimal demand from patients or physicians.
Believing that unnecessary use of resources is a significant contributor to rising health care costs, the ABIM Foundation launched the Choosing Wisely campaign, in which physicians and patients work together to develop treatment plans that are effective for the patient but are also efficient and promote the sustainable use of limited resources.
Comparative effectiveness research (CER) may become an important factor in Medicare coverage decisions, and the new health care law may make it more easily available to the public to help in medical decision making.
Extensive resources are required for its implementation, but there is a strong case that bar-code medication-verification technology should be a required practice for demonstrating "meaningful use" of health information technology under the American Recovery and Reinvestment Act.
Anthony C. Rudine, MD, MBA and Jennifer P. Jennifer, PharmD
The authors recommend that pharmacists be consulted in the use of nephrotoxic parenteral medications in children to minimize any potential adverse reactions.
The relationship between conventional and alternative medicine is wary at best. What is needed is expanded medicine, which encompasses the best that both kinds of medicine have to offer.