May 26, 2015


'Less Is More': The Next Big Thing for Medicine (Joan Stephenson PhD, 5/26/15, MedPage) 

The less-is-more movement has percolated against this backdrop over the past decade, gaining traction with the 2012 launch of the Choosing Wisely campaign by the American Board of Internal Medicine (ABIM) Foundation. The campaign enlisted clinician groups to help galvanize change by naming an evidence-based top 5 list of tests and procedures that physicians and patients should question because they offer little or no benefit and may cause harm.

To date, more than 70 specialty societies have joined the campaign, each offering a top 5 list (some later updated to a top 10 or 15 list). Consumer Reports and other consumer groups have also signed on to help educate patients about how more medicine can be harmful.

In addition, major medical journals are highlighting research findings that provide data illuminating low-value care, including the JAMA Internal Medicine Less is More series and the BMJ's Too Much Medicine campaign. Annual conferences, such as Preventing Overdiagnosis and the Lown Institute-sponsored RightCare Conference, are raising the medical community's consciousness about medical overuse.

Some specialty groups embraced the challenge, and despite potential effects on their members' financial bottom lines, presented top 5 lists that included services often performed within their own specialty that could be considered low value.

For example, the Society of General Internal Medicine advised against the routine annual physical, and the American College of Radiology listed five imaging tests to avoid under certain circumstances, such as admission or preoperative chest x-rays for ambulatory patients without specific findings from the physical exam and history.

But in an analysis reported last year, researchers at Dartmouth and Harvard pointed out that 83% of the tests and procedures selected by medical groups, especially "proceduralist societies," for their top 5 lists are either rarely done or are typically performed by clinicians in other fields.

"One of the interpretations of this was that specialty societies weren't choosing things that affected their own revenue streams, they were choosing things that affected others' revenue streams," said Carrie H. Colla, PhD, one of the Dartmouth researchers who co-authored the analysis.

Posted by at May 26, 2015 7:52 PM

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