In my previous communication I discussed the derivation of patient centered care and why it is so important to empower the patient when making medical decisions in their care. In this article, “Cassel: Doctor-patient relationship needs to rest on even ground,” Dr. Christine Cassel former president of the American College of Physicians, the American Board of Internal Medicine and currently CEO of the National Quality Forum speaks about actions currently being taken to accomplish this. Dr. Cassel has launched a campaign: “Choosing Wisely” in which physicians are taught through video demonstrations how to provide information to patients that is informative and responsive to their needs. Patient and physician simulated interviews show the ways in which physicians can listen actively and more effectively inform patients on key issues. Dr. Cassel believes that this campaign “is empowering the patient to have that conversation with the doctor, and for the doctor and the patient to have the same information, the same evidence-based science.”
This program currently is linking with all the major subspecialties in medicine and each subspecialty has identified key areas to be communicated with patients. The ABIM has linked to the American Gastroenterology Association and to come up with several programs of relevance to gastroenterology. This includes how to inform a patient that they do not need a colonoscopy for 10 years if they have no polyps seen at the time of current procedure, or that they do not need an endoscopy less than every 3 years to screen for cancer in patients with Barrett’s esophagus. I was privileged to write a program to address how to inform patients that they do not need another CT scan for chronic pain when a recent one was negative . Watch my demonstration of this communications technique.
All of these programs help patients make advised decisions regarding costly and unnecessary procedures. As Dr. Cassel comments, this approach can prevent a “therapeutic cascade” where a minor abnormality in test results can lead to a doctor suggesting more procedures; perhaps because he or she genuinely thinks they’re needed, but sometimes because the current fee-for-service model provides a financial incentive. This trickle of tests can quickly turn into a deluge. With proper information the patient and physician can make decisions to reduce unnecessary and expensive procedures.
For information on ways to communicate more effectively with patients and health care providers go to www.drossmancenter.com . Appointments for clinical care can be made at www.drossmangastroenterology.com
Douglas A. Drossman MD