The ChoosingWisely campaign looks very interesting (helping Patients to choose wisely by letting them share info and consult with independent impartial Doctors is the reason we launched 3G Doctor in 2006) but it seems to be a classic case of Doctors failing to see the wood for the trees.
I personally find it quite hard to take the findings seriously when you read that plaster casts costing a few £’s for children who have injured their wrists are somehow topping the list of wasteful practices, but it’s impossible to overlook the reality that most of these wasteful practices being pointed to are so commonplace because the alternatives aren’t being funded eg. a GP can refer a Patient for a myriad of expensive treatments/tests that have been sold to the NHS/HSE by teams of well funded and persistent sales professionals but most find they can’t even use the tools of our time with their Patients and there isn’t even the capacity to prescribe inexpensive services:
I think it’s also key that campaigns are realistic in their ambitions eg. with most Patients being interrupted within seconds of starting to talk what evidence is there that the suggested list of 5 additional questions for Patients to ask their Doctors will be welcomed by their Doctors?
The vast majority of medical consultations remain undocumented so I think it’s also highly unlikely the quality of the care will be improved if we have Patients focused on asking (and trying to remember the answers they’re told) this extra set of questions (perhaps they should be integrated into the clinically validated Patient History Taking questionnaires that Patients are already using to communicate with their Doctors?):
I think the answer to the “What if I do nothing?” question the campaign wants Doctors to ask of themselves is that all too often it’s not on option for fear of a complaint/solicitors letter. Perhaps the ChoosingWisely campaign would have better results if it focused on educating Patients on the harms caused by the practice of defensive medicine.
Overall I think the campaign is largely a missed opportunity because clearly the biggest opportunity we have to ‘Choose Wisely’ is when we let Doctors choose if this concern is something that will be best served by an office visit.