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Choosing Wisely

Choosing Wisely. Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine. Choosing Wisely Campaign. Started by the ABIM Foundation in 2012 60 medical societies have joined

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Choosing Wisely

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  1. Choosing Wisely Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine

  2. Choosing Wisely Campaign • Started by the ABIM Foundation in 2012 • 60 medical societies have joined • List of 5 things (tests or treatments) that should not be done • Educate doctors – the medical societies • Educate patients – Consumer reports • https://www.youtube.com/watch?feature=player_embedded&v=bEYTnS7dCAg

  3. Examples - Geriatrics • Don’t use feeding tubes in patients with advanced dementia; instead offer oral assisted feeding. • Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better. • Healthy – 7.0%-7.5%, many conditions – 7.5%-8.0%, frail 8%-9% • Avoid using prescription appetite stimulants or high-calorie supplements for loss of appetite and weight loss in older adults; • Instead, optimize social supports, provide feeding assistance and clarify patient goals and expectations.

  4. Examples – Long Term Care • Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy. • Don’t use sliding scale insulin for long-term diabetes management for individuals residing in the nursing home. • Don’t prescribe antipsychotic medications for behavioral and psychological symptoms of dementia in individuals with dementia without an assessment for an underlying cause of the behavior. AMDA

  5. Other Examples -Miscellaneous • Don’t order sinus CTscans or indiscriminately prescribe antibiotics for uncomplicated sinusitis. • Don’t diagnose or manage asthma without spirometry. • Don’t do imaging (CT or MRI) for low back pain within the first six weeks, unless red flags are present. • Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms.

  6. More examples • Don’t screen for carotid artery stenosis in asymptomatic adult patients. • Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam. • Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience.

  7. A Few More • Don’t get a chest X-ray before surgery in the absence of a clinical suspicion for chest pathology. • Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals. • Don’t perform neuroimaging studies in patients with stable migraine headaches. • Don’t prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for GI complications.

  8. So – What Do You Do? • Whenever a treatment of a test is recommended, ASK: • What are the risks? • What are my options? • What will happen if I don’t do anything? • (get real numbers, not threats)

  9. A Revolution in Health Care • Clinicians and patients working in partnership • Knowing the magnitude of the benefit of treatment • Knowing the potential harms – side effects, costs, inconvenience • Realizing that health decisions are YOUR decisions

  10. Be An Activated Patient! • https://www.youtube.com/watch?feature=player_detailpage&v=FqQ-JuRDkl8

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