Enhancing Patient-Centered Care: SGIM and Choosing Wisely
Laurence F. McMahon Jr
1
3
10
Rebecca Jennifer Beyth
0
Alfred Burger
7
Vineet Chopra
MSc
3
6
10
David Feldstein
5
Deborah Korenstein
4
Usha Subramanian
9
Jeremy Sussman
MSc
3
6
10
Brent Petty
8
Jeff Tice
2
0
Department of Internal Medicine, University of Florida, Malcom Randall VA Medical Center
,
Gainesville, FL, USA
1
Department of Health Management and Policy, University of Michigan
,
Ann Arbor, MI, USA
2
Department of Internal Medicine, University of California
,
San Francisco, San Francisco, CA, USA
3
Division of General Medicine
,
Ann Arbor, MI, USA
4
American College of Physicians
,
Philadelphia, PA, USA
5
Department of Internal Medicine, University of Wisconsin
,
Madison, WI, USA
6
Ann Arbor VA Medical Center
,
Ann Arbor, MI, USA
7
Department of Internal Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine
, New York City,
NY, USA
8
Department of Internal Medicine, Johns Hopkins University
,
California, MD, USA
9
Department of Internal Medicine, Indiana University
,
Indianapolis, IN, USA
10
Department of Internal Medicine, University of Michigan
,
Ann Arbor, MI, USA
-
O Medicine, whether practiced in an ambulatory care
ne of the touchstones of academic General Internal
setting or at the patients bedside, is its focus on enhancing
and teaching patient-centered care. In an era of increasing
cost consciousness, patient centeredness requires
thoughtful, ongoing discussions about the risks and benefits of a
myriad of medical tests and procedures. Against this
backdrop, the Society of General Internal Medicine (SGIM)
chose to participate in the American Board of Internal
Medicine Foundations Choosing Wisely initiative.
The Choosing Wisely initiative aims to promote
conversations between patients and their physicians around tests and
procedures whose necessity should be questioned and whose
potential harms and benefits clarified within the context of
each patients care plan. To date, 54 medical societies and 17
consumer groups have identified 280 potentially unnecessary
medical tests and treatments that are commonly performed in
the United States.1 To further assist patients in engaging with
their physicians in discussions about these tests and
procedures, Consumer Reports is partnering in this process to
develop and disseminate materials for patients through large,
publically oriented consumer groups. This alliance of science,
advocacy and policy is ultimately designed to improve patient
care and clinical outcomes, and reduce wasteful and
unnecessary healthcare expenditures.
In discussing health care costs and the Choosing Wisely
approach, Castle and Guest from the American Board of
Internal Medicine (ABIM) Foundation note, The initial
focus should be on overuse of medical resources, which not
only is a leading factor in the high level of spending on
healthcare but also places patients at risk of harm.2 Some
estimates suggest that as much as 30 % of all healthcare
spending is wasteful.3 Volpp and colleagues also identify
the promise of the Choosing Wisely initiative when they
note, The Choosing Wisely initiative represents an
important first step toward the identification of low-value
services, more meaningful because it is a step taken jointly
by consumer groups and professional societies.4 They go
on to note, Given fiscal realities, reducing low-value
services is what will allow continued support for the
coverage of high-value services.4
The ad hoc SGIM Choosing Wisely Committee was
selected from the existing SGIM Clinical Practice Committee,
and the Evidence-based Medicine Task Force, as well as
selected society members. The goal of the ad hoc committee
was to identify important topics for academic general internal
medicine faculty across the spectrum of clinical practice. The
committee operated under a few notable constraints. First,
there had to be existing evidence on the selected topic, as there
was no opportunity to construct new systematic reviews or
evidence syntheses as part of the process. Second, the
Choosing Wisely initiative was limited to five topics or
recommendations.
Given these operating parameters and the interest in
selecting topics across the spectrum of academic practice,
the committee began by internally soliciting topics for
consideration. These topics were then circulated to all
committee members and an initial vote was taken to identify
the top ten topics. Subsequently, the committee sought to
establish the evidence base for each of the ten topics, and
then conducted a conference call to determine relevant
domains through which to weigh the selection of the final
five topics. The agreed-upon relevant domains included: the
strength of the evidence-base for that particular
recommendation; our standing on the topic as general internists; the
number of patients likely to be affected by the
recommendation; the financial impact of the topic; the relative cost
effectiveness of the intervention; and potential harm to the
patient. The top ten topics were then (...truncated)