Senior Medicine: When ‘More’ Isn’t Better

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As much as a fifth of United States medical care is unnecessary. This represents $250 billion annually—and perhaps more important, it means patients are undergoing hundreds of thousands of procedures and prescriptions that have no benefit, and quite possibly cause them some harm. Choosing Wisely is a 5-year-old medical initiative based on the premise that the best outcomes often result from saying ‘no’ to tempting procedures, tests and prescriptions. But this movement to slow down excessive eldercare is crashing directly into the culture of medicine that, for various reasons, likes to administer a lot of care.

Choosing Wisely guidelines were developed by the American Board of Internal Medicine Foundation “to bridge the divide between two driving philosophies in U.S. medicine—the idea of physician autonomy built upon an almost mystical ‘physician-patient dyad’ . . . and a century’s worth of momentum toward evidence-based improvement and standardization of medicine.”

Allen reports that doctors at one health system that has adopted the new approach, the Dartmouth-Hitchcock Medical Center in New Hampshire, have “reduced unnecessary preoperative tests from 23 percent to 4 percent over a three-month period by incorporating Choosing Wisely guidelines into the electronic records their doctors use, according to a recent study.” Yet, Allen also documents skeptic about the voluntary program, as well as institutional barriers to its wider adoption.

Arthur Allen developed his story support by a Journalists in Aging Fellowship from New America Media and the Gerontological Society of America with sponsorship from the Silver Century Foundation.