PHOTO PROVIDED BY DONALD E. WESSON, MD
QUALITY
Quality in action TMA helps doctors implement “Choosing Wisely”
BY AMY LYNN SORREL In 1991, Temple nephrolo- gist Donald E. Wesson, MD, showed up at his physi- cian’s office in excruciating pain. After an initial exam, the doctor ordered an in- travenous pyelogram (IVP), which revealed kidney stones. It was the first time Dr. Wesson was diagnosed with the ailment. “That was a useful use of IVP,” the chief academic officer at Baylor Scott & White Health said.
The second time he had
the pain, hospital protocols still called for an IVP, even for patients with a history of kidney stones. “My ques- tion to my doctor, between my screams, was: How is an IVP going to contribute to my care, when you know and I know I have a history of kidney stones, and that’s not likely to be affected by the results of IVP?”
The test also carried
aims to improve quality and reduce waste by getting physi- cians and patients talking about medical tests and procedures that may be unnecessary and possibly harmful. (See “Choos- ing Wisely: More Value, Less Waste, Shared Decision Making,” December 2012 Texas Medicine, pages 25–29.) To date, more than 30 medi- cal specialty societies have joined Choosing Wisely to iden- tify and create lists of the top five tests and procedures they say are inappropriate or over- used.
Donald E. Wesson, MD, not only leads the Choosing Wisely campaign, but also knows from personal experience as a patient that “quality care is not necessarily the most care.”
some risks with it — some patients are allergic to the dye, for example — and the proce- dure costs money.
He ultimately convinced his doctor the test wasn’t neces-
sary. “Quality care is not necessarily the most care. So in this instance, by not having an IVP done, I got better care because it focused the doctors on what needed to be done; it saved me potential risks; and it saved me and the health care system dollars.” That’s the gist of the national Choosing Wisely campaign,
which Dr. Wesson leads as chair of its creator, the American Board of Internal Medicine (ABIM) Foundation. The program
But those lists do little good staying on paper, which is why the Texas Medical Association is helping physicians incorporate the program into daily practice. TMA sees Choosing Wisely as a vehicle for quality improvement and is one of only five state medical associations to win a grant from ABIM to promote the campaign in partnership with the TMA Foundation. Choosing Wisely also could factor into statewide quality improvement
initiatives, including those being considered by the Texas In- stitute of Health Care Quality and Efficiency. “Choosing Wisely has tremendous potential to align the in-
terests of the patient and the interests of the clinician. These really are things that contribute to unnecessary cost and risks. And [the lists] can serve very nicely as a communication tool to facilitate that conversation between the physician and the patient,” said Ronald S. Walters, MD, a Houston oncologist and member of TMA’s Council on Health Care Quality. The TMA House of Delegates voted last year to endorse the program after receiving initial approval from the council
January 2014 TEXAS MEDICINE 51
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