Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

ACP: 5 excuses physicians and patients should question

Yul Ejnes, MD
Physician
March 13, 2013
Share
Tweet
Share

acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

Whether we call them “unnecessary,” “not indicated,” “inappropriate,” or “overused,” certain tests and procedures add little or no clinical benefit to patients and in some cases they cause harm. They also contribute to the cost of care without improving care. At a time when payers are challenging payment for legitimate services that patients need, the medical profession should lead the way in reducing the wasteful medical care over which they have control.

On February 21, Choosing Wisely, an initiative of the ABIM Foundation, announced the participation of 17 additional medical societies, each of which released a list of five commonly done tests or procedures whose use should be questioned by physicians and patients. ACP was one of the first groups to release a list in April 2012, and prior to that established its High Value Care initiative that shares the goals of Choosing Wisely. More societies will publish their own lists later this year.  I won’t describe the items here but suggest that you read them on the Choosing Wisely webpage.

In the spirit of the Choosing Wisely campaign, I would like to add my own list of five items. These items are not tests or procedures, but excuses that physicians and patients should question. They are reasons that some physicians raise for not following recommendations such as those in Choosing Wisely. I came across all of these following the recent ABIM Foundation announcement.

Here is my list of five commonly-used excuses for not implementing recommendations for high value care:

1. We can’t follow these recommendations without tort reform. This is probably the most widely-used excuse and my favorite. Whenever a study or guideline advises against doing something, we hide behind the lawyers to justify not changing our ways. The logic goes something like this: if we don’t do the unnecessary test and something bad happens to the patient, then we will be sued. That argument has a few holes in it. We’re not talking about the capricious omission of recommended testing here but avoiding tests for conditions that are very unlikely to be present, tests that may create a problem where one didn’t exist.  In addition, the excuse ignores the other side of the argument. If a patient experiences a complication from a procedure that was not necessary (think contrast reaction during a CT to follow up on an incidental finding) will the lawyers give you a free pass because you were “being thorough?”

2. These recommendations are another step towards rationing. High Value Care, Choosing Wisely, and all of the similar initiatives that preceded them focus on potentially unnecessary testing and procedures that may harm patients without benefitting them. How is not performing a risky test that won’t help a patient (or might even hurt them) rationing?

3. The government should leave us alone and let us practice medicine. This is a variation of the same conspiracy thinking that gave us “death panels.” The “government” is not telling us what to do or not do. The conversation about the appropriateness of testing and procedures started long before the government started talking about the cost of medical care. It is a fundamental part of what we teach medical students – it was in the medical curriculum when I was a student in the 1980s. Our profession is leading the discussion because that is what a true profession does.

4. These recommendations are just another insurance company gimmick to save money. While insurers (and employers, for that matter) are supportive of these efforts and may see a decline in their health care costs, they are not the driving force behind these campaigns. As noted above, the medical profession is leading this movement. When I read or hear this excuse, I sometimes wonder if some of the resistance to these recommendations is driven by concerns about loss of income.

5. I know what my patients need and don’t need a group of ivory tower-types telling me what to do. I call this the “ego excuse.” The physician groups that make these expert recommendations include members from a variety of practice settings, including private practice. And they are recommendations, not commandments. They are a call for all of us to pause and ask the simple questions of “Is this test or procedure really necessary?” and “Will it improve the health of the patient?” This excuse ignores a fundamental principle of being a profession, which is that of self-evaluation of what we do as physicians.

One organization submitted a second list of five items in the recent Choosing Wisely release.  I could probably release a second list of five excuses. Perhaps I will in a future post. Then again, we may even see some of them in the responses to this post.

Yul Ejnes practices internal medicine in Cranston, Rhode Island, and is the Immediate Past Chair, Board of Regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

Prev

Home genetic testing raises more questions than answers

March 12, 2013 Kevin 5
…
Next

Death by voluntary cessation of fluids and nutrition needs discussion

March 13, 2013 Kevin 42
…

ADVERTISEMENT

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
Home genetic testing raises more questions than answers
Next Post >
Death by voluntary cessation of fluids and nutrition needs discussion

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Yul Ejnes, MD

  • Different perspectives but the same goal: providing the best possible care to patients

    Yul Ejnes, MD
  • Rising premiums, high deductibles, and gaps in coverage before the ACA

    Yul Ejnes, MD
  • Improving physician satisfaction by eliminating unnecessary practice burdens

    Yul Ejnes, MD

More in Physician

  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • A day in the life of a WHO public health professional in Meghalaya, India

    Dr. Poulami Mazumder
  • Why women doctors are still mistaken for nurses

    Emma Fenske, DO
  • Adriana Smith’s story: a medical tragedy under heartbeat laws

    Nicole M. King, MD
  • Why U.S. health care pricing is so confusing—and how to fix it

    Ashish Mandavia, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

ACP: 5 excuses physicians and patients should question
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...