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Maine starts Choosing Wisely initiative

A Maine-based initiative of a national campaign to rein in unnecessary care began to take shape Wednesday at a daylong conference focused on making the state the first in the nation to achieve the Triple Aim.

During Maine Quality Counts’ “Aligning Maine’s Forces to Become the First State to Reach the Triple Aim” conference, Lisa Letourneau, MQC’s executive director, announced that MQC and other state partners are spearheading a statewide version of Choosing Wisely.

Choosing Wisely is a campaign developed by the American Board of Internal Medicine Foundation (ABIM) in partnership with Consumer Reports magazine to promote and encourage conversations between physicians and patients about potentially unnecessary care.

Since it began in 2011, more than 40 medical specialty societies have joined the campaign by identifying commonly used procedures and tests that may be overused in their specialties.

[See also: Medical specialty societies expand assault on unnecessary procedures.]

ABIM’s President and CEO, Christine Cassel, MD, moderated two panels devoted to what Maine’s Choosing Wisely initiative will look like.

In the morning, panelists discussed the importance of forging relationships and trust between providers and between providers and patients.

“When we talk about doing Choosing Wisely,” said Steve Diaz, MD, of MaineGeneral Health, “you need to have some agreement on what protocols you’ll live by. If you can have agreement that if we share a GI patient … and this is the protocol we’ll follow and we’ll live to that and we won’t throw each other under the bus – think abut the impact. If you no longer think you have to cover yourself to look smart, or talk to a patient about why it did not go well … that’d be huge. Defensive medicine goes down. This isn’t about insurance. This isn’t about malpractice. This is about being human.”

While providers can begin to form trusting relationships with each other by getting out of their silos, they also must take the initiative to reach out to their patients, too, said Jeffrey Aalberg, MD, of MaineHealth. Models like patient-centered medical homes are ways in which the infrastructure can help facilitate stronger relationships between patients and doctors, he noted, while others on the panel said that things like inviting patients onto patient advisory councils are of value.

Renee Grant, a patient advocate and member of MQC’s consumer advisory board council, noted that patients have a role to play, too, and that the Choosing Wisely campaign helps patients fulfill their role by giving them the words to start a conversation with their doctor.

When a speaker in the audience worried about the possibility of being sued by patients if doctors don’t offer every test or procedure available, Erik Steele, DO, of Eastern Maine Health Systems said physicians can’t use malpractice as an excuse any more.

“I think the malpractice issue is legit,” he said, “but I think it’s time for physicians to stop, frankly, to some extent, hiding behind it and try to deal with it more directly.”

He recommended that providers be upfront with patients that they are changing the way they practice to avoid unnecessary procedures and tests. He said doctors should have conversations with their patients explaining the change in practice and giving them the option of going to another practice if they are uncomfortable with the change.

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