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47 Two cheers for choosing wisely: a consumer perspective
  1. Dena Davis
  1. Lehigh University, Bethlehem, USA


Choosing Wisely’s effectiveness has been disappointing, and commentators are asking where it misses the boat. This presentation critiques the Choosing Wisely project from the perspective of a healthcare consumer who tried to use it.

When I decided to have cataract surgery I needed a specialist surgeon. My appointment with him was impressive: a clear explanation of the procedure, the risks and benefits, and adequate time for questions. After hours of tests, I was decanted into the office of the scheduler, who gave me an appointment for surgery three months later. She also told me to contact my PCP for an EKG. When I looked at the CW website, I realized that I should have questioned the EKG. But when I called to have the ‘conversation’ CW was founded to support, I was stymied at every turn. No one at his office would allow me to speak with him when they found out what I was calling about. EKG’s were ‘routine,’ and not open for discussion. My PCP agreed that the EKG was unwarranted and she tried to call; she was also stonewalled. At the same time this was happening, the American Academy of Opthalmology’s website featured this very issue, emphasizing that routine EKG’s are not recommended. ‘[The AAO urge[s] you to have a conversation with your ophthalmologist to discuss if preoperative tests are important for you,’ chirps the website, but how can I have a conversation if the guy doesn’t know I am trying to call?.

Resorting to snail mail, I did finally get a response from the surgeon, agreeing with my concern, but regretting that the surgery center required the EKG. Should I jettison the time and money I had already spent with this surgeon and start all over again? Or should I subject myself to an unnecessary EKG, courting the possibility of a medical cascade that could lead to risky, unnecessary, invasive procedures? In the end, I went through the charade of the EKG (which, of course, my insurance company happily paid for). So where did CW get me? I ended up feeling adversarial and angry with someone who was about to put sharp objects in my eye.

My conclusions: 1- CW urges consumers to ‘talk with’ their physicians as if we were still in the days of Marcus Welby, MD. There is no acknowledgment that physicians are embedded in hospitals and bureaucratic systems that make just getting to them difficult. CW could offer tips to navigate the system. 2- Insurance companies need to stop paying for low-value care. 3- CW holds itself out as a site for healthcare consumers, but it is actually geared to the underlying assumption that it is consumers who are the problem. There are videos helping physicians to explain to patients why they don’t need a specific test or medication, but no videos helping patients to challenge doctors who are recommending low value care. Despite its stated values, CW actually has a strong paternalistic flavor.

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