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My view: Is more always better? Not in health care

By Korey Capozza

For the Deseret News

Published: Thursday, March 27 2014 12:00 a.m. MDT

The more we spend on ineffective care, the less money we have for effective care. Not to mention the potential for patient harm, excessive use of antibiotics can lead to resistant bacteria, and surgery comes with its own set of risks.

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Have you ever tried to fix something and ended up making it worse? Maybe you spilled something on your shirt, and wiping it with your napkin just enlarged the stain.

Or you tried adding some spices to a recipe to mask another flavor, but you succeeded only in making the whole dish inedible. In each case you may have suspected up front that you’d be better off leaving well enough alone — but that urge to fix things can be tough to resist.

This comes up all the time in health care. Parents insist on an antibiotic from their pediatrician when a child has a runny nose and cough that just wouldn’t go away. Or a worker with chronic low back pain shops for a new doctor willing to operate when his current one tells him surgery is not the best option. These familiar examples illustrate the rationale behind the Choosing Wisely campaign, a national effort to raise awareness about common medical procedures that are overused, unnecessary and/or potentially harmful. The goal is to help doctors and patients collaborate toward better-informed decisions.

The Institute of Medicine estimates that 30 percent of health care spending goes to ineffective or unnecessary care. Why is there so much waste in our system? Part of the reason is that doctors and patients alike often want to pursue all their options, even the ones unlikely to work. Doctors don’t want to shortchange patients; and patients want immediate answers to their health problems — and access to all the care that’s available to them.

But clearly our ingrained habits need to change. The more we spend on ineffective care, the less money we have for effective care. Not to mention the potential for patient harm, excessive use of antibiotics can lead to resistant bacteria, and surgery comes with its own set of risks.

The national Choosing Wisely campaign is sponsored by the ABIM Foundation, which has partnered with national physician organizations to lead the way on this issue. Each physician group has identified tests and procedures within its own specialty that are generally considered overused, and Consumer Reports has translated these recommendations into readable educational materials for patients.

Here in our own state, a diverse group of local health care, business and community leaders recently launched Choosing Wisely Utah. We are initially focusing on five specific treatments, tests and procedures that warrant more scrutiny in the form of conversations between patients and their doctors. And this spring, Choosing Wisely Utah is hosting a series of town hall events to start a community dialogue about this issue. The first of these will occur at the Hinckley Institute for Politics on March 27 from 4-5:30 p.m. We invite the public to attend these events to learn more.

At its core, the Choosing Wisely campaign is about helping patients get the right care at the right time. We believe this will lead to a stronger, more efficient and more effective health care system.

Brian Jackson, M.D., M.S., is an assistant professor of clinical pathology at the University of Utah and vice president at ARUP Laboratories. Korey Capozza, MPH, is consumer engagement director at HealthInsight.

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