COMMENTARY: Choosing Wisely: Good Care With Efficiency


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Richard J. Boxer, MD, FACS

Is more care better care?

It is often said, by Americans, that the United States has the best care in the world. However, there are many population-based statistics that do not support that humble opinion. We certainly spend more money than any other nation by far. In fact, we may spend more money than nearly all other countries in the world combined. This begs a number of questions:

(1) Are we getting our money’s worth?

(2) Are patients being overtested and overtreated?

(3) Can we physicians together decide what is reasonable to discuss with our patients to avoid unnecessary treatments and tests, and yet simultaneously improve care?

Yes We Can

The answer to these questions is “Yes.” A program originally conceived by the National Physicians Alliance through an America Board of Internal Medicine (ABIM) Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine, and pediatrics could take in their practices to promote the more effective use of health-care resources. These lists were first published in Archives of ­Internal Medicine.

Pursuit of Excellence

Over 50 national medical organizations have created discussion points that emphasize quality of care without overtesting and overtreating. ASCO has been a leader in this extraordinary pursuit of excellence and has created its own set of recommended topics for discussion and consideration.

As a demonstration of the perceived value of this effort, private companies have developed sets of discussion points that help guide patients at the time of tremendous stress.

Once again, and appropriately so, our physician colleagues are taking the leadership role in creating better care for our patients. It is now up to all of us to follow the guidelines. ■

Dr. Boxer is Visiting Professor at the David Geffen School of Medicine at UCLA, Clinical Professor at the University of Wisconsin, Madison, and the Medical College of Wisconsin (Milwaukee), and former Professor of Clinical Urology at the University of Miami.


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