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Patient Trust in Physicians and Reducing Harmful or Wasteful Care

Tuesday, May 24, 2016
Jeff Rideout, MD

During a recent webinar about the Doing What Works (DWW) project—an offshoot of IHA’s  work with  the Statewide Workgroup on Reducing Overuse—I was reminded that one of the most powerful but sometimes underused tools available to physicians is their patients’ trust.

And it made me think about the role of patient trust in reducing unnecessary care and how physicians might tap into that trust to help patients understand the potential risks of care like antibiotics for viral infections or elective C-sections.

DWW gathered public views about unnecessary care through public deliberation—a unique way of convening citizens to learn about an ethical or value-laden issue and to consider alternative, often competing, perspectives. Deliberation stresses neutral, objective education, consideration of all sides of an issue, and balancing broader societal concerns with individual points of view.

In essence, the project asked participants to take off their patient hats and put on their citizen hats to answer the question: “What strategies are most acceptable for reducing the use of medical care that is harmful and/or wasteful?” Participants received factual background information about overuse of antibiotics for adult bronchitis, C-sections for first-time normal pregnancies and MRIs for common low back pain and then discussed options for reducing inappropriate use. Read the DWW executive summary or the full report

Once DWW participants understood the magnitude of the problem, they were much more willing to set boundaries to reduce unneeded care, primarily through greater oversight of physicians by other physicians. At the same time, because of their profound trust in their physicians, DWW participants were extremely wary of any external attempts to interfere with the patient-physician relationship, restrict patient choice, or diminish physician autonomy.

As the webinar participants— Lance Lang, M.D., of  Covered California; Julia Logan, M.D., M.P.H., of the California Department of Health Care Services; Marge Ginsburg, of the Center for Healthcare Decisions; and Beccah Rothschild of Consumer Reports—discussed, it’s extremely difficult for people to reconcile the roles of patient and citizen.

“People in the exam room aren’t wearing their citizen hat. They’re uncomfortable, they’re in pain, and they’re looking for help,” Lang said during the webinar.

But patients in the exam room do trust their physicians, and because of that sacrosanct trust, I’m more convinced than ever that without physician buy-in and leadership, we’ll make little headway in reducing unnecessary care.  Fortunately, physicians are stepping up through initiatives like the ABIM Foundation’s Choosing Wisely® campaign, which helps clinicians and patients engage in conversations about the overuse of tests and procedures and supports physician efforts to help patients make smart and effective care choices.

Under a Choosing Wisely grant, IHA is partnering with Sharp Rees-Stealy Medical Group in San Diego County; Sutter Health in the Sacramento/Central Valley/San Francisco Bay areas; the California chapter of the American College of Physicians; the Center for Healthcare Decisions; and Blue Shield of California to reduce overuse of antibiotics for adult bronchitis, diagnostic testing for low back pain, pre-operative stress testing, imaging for uncomplicated headache and repetitive complete blood count and chemistry testing.

 

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