Monday, 22 December 2014

Recommendations against low value clinical practices. Are they useful?

Owen Dyer, a journalist and regular contributor to the British Medical Journal, following the Choosing Wisely campaign from the ABIM Foundation (a list of recommendations for clinical practice that both doctors and patients should question) in the US, makes an assessment of whether the lists of recommendations against low value clinical practices will manage to change the status quo or, on the contrary, the dynamics of the system will engulf them as it has done with many other initiatives.

To overshadow the effectiveness of the instrument, Dyer has chosen a quote from the writer Upton Sinclair: "It’s difficult to get one to understand something, especially if one’s salary depends on not understanding it." Anyway, the journalist believes that if doctors are not able to fight with strict clinical criteria against the waste of so many useless tests and excessive treatment, the insurers and the governments will end up being the ones that should do it and, logically, they’ll do it ineffectively, at least as far as people’s health is concerned.

Why did I choose to be a doctor? That is the question. The Choosing Wisely campaign is about professionalism, not measurements nor incentives, and it’s here Dyer says, where we have to advance. Doctors swore not to harm people with their actions, the journalist continues reasoning, and for this reason they should be very careful not to be part of clinical actions that are known to be dispensable.

Jordi Varela

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