Choosing Wisely. Most of the Time

Choosing Wisely.  Most of the Time

This week was an excellent Grand Rounds on some of the reasons doctors do what they do. Partly it is habit. We learn to practice a certain way of practice early in our career and it carries on into practice and it is not always best practice. Patients also learn from us and have expectations on what diagnostics or treatments they should receive, and it is not always the best practice.

To educate physicians and patients, the ABIM started the Choosing Wisely initiative.


Their goals:

Choosing Wisely® aims to promote conversations between providers and patients by helping patients choose care that is:

▪ Supported by evidence

▪ Not duplicative of other tests or procedures already received

▪ Free from harm

▪ Truly necessary

To do this they asked various medical societies for 5 or more do's and don'ts.

In the world of pseudo-medicine, they have one win from American College of Medical Toxicology and The American Academy of Clinical Toxicology:

  • Don’t use homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.
  • Don’t administer a chelating agent prior to testing urine for metals, a practice referred to as “provoked” urine testing.
  • Don’t order heavy metal screening tests to assess non-specific symptoms in the absence of excessive exposure to metals.
  • Don’t recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples.
  • Don’t remove mercury-containing dental amalgams.

and two fails. One for low back pain:

If you don’t feel better after four weeks or so, it might be worth talking with your doctor about other options, including physical therapy, chiropractic care, yoga, massage, acupuncture, cognitive-behavioral therapy, and progressive muscle relaxation.

and the other for choosing a pain releiver:

Staying physically active often helps. Acupuncture, massage, physical therapy, and yoga, might work, too. Chiropractic care might also be beneficial.

Both acupuncture and chiropractic do not meet the four criteria of the organization, so do not belong on the list.

It is also ironic that while the ABIM is striving to improve care with the initiative, many organizations are institutionalizing pseudo-medical therapies in Integrative Medicine Departments that meet none of the Choosing Wisely criteria.

What SBM givith, pseudo-medicine taketh away.

Points of Interest 11/08/2014
Points of Interest 11/06/2014