Guest Blog: Bringing Choosing Wisely® to Life by Jean Hanvik

I am a huge fan of the Choosing Wisely campaign, although it is deceptively simple in concept: Providers do no harm; consumers be aware.

As a health care and benefits communications professional with over two decades of experience and a passion for improving health literacy, what impresses me most about Choosing Wisely is how it is opening up once-taboo conversations between patients and their doctors.

HEALTH LITERACY is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Health literacy is dependent on individual and systemic factors: Communication skills of lay people and professionals.

By normalizing conversations that have been notoriously off limits, Choosing Wisely enables a return to care that focuses on the physical, mental, emotional, and financial health of the patient. With a health care system that rewards volume, and a culture that discourages shared decision-making and encourages a “more-is-better” approach, change will be slow in coming.

When Choosing Wisely and Doctor’s Orders Collide

I have a relatively minor medical condition with symptoms that make for an easy diagnosis. It has flared up three times in eight years and, at my long-time doctor’s insistence, I have had an abdominal CT scan each time, despite the fact that the diagnosis is simple and treatment simpler—two antibiotics, twice a day, for two weeks­.

I was somewhat alarmed when I recently learned through Choosing Wisely that an abdominal CT scan is one of the higher radiation exposure X-rays, equivalent to three years of natural background radiation. Recommendations state that it should not be repeated unless there is a major change in clinical findings or symptoms.

Should it have been my doctor’s responsibility to bring this to my attention (providers do no harm)? Or should I have been more alert about the risks and benefits (consumers be aware)? I believe it should be a combination of the two, with the greatest pressure exerted on doctors who are expected to consider what is best for the patient.

Unfortunately, only one in five doctors is aware of Choosing Wisely—and survey results show that even among doctors who do know about the campaign, 53 percent say that when a patient asks for an unnecessary test or procedure, they order it anyway. So, patients, too, need to learn that “choosing wisely” in their own lives means making thoughtful, well-reasoned decisions.

What Can Employers Do?

Nearly nine out of 10 adults have difficulty using the everyday health information that is routinely available, according to the U.S. Department of Health and Human Services (HHS). Without clear information and an understanding of prevention and self-management of conditions, people are more likely to skip necessary and insist on unnecessary medical tests. They also end up in the emergency room more often, and have a hard time managing chronic diseases.

There is an HHS National Action Plan to Improve Health Literacy, which seeks to engage organizations, professionals, policymakers, communities, individuals, and families in an effort to improve health literacy. The plan is based on the principles that (1) everyone has the right to health information that helps them make informed decisions, and (2) health services should be delivered in ways that are understandable and beneficial to health, longevity, and quality of life.

The vision informing this plan is of a society that:

Here are seven things from the Action Plan employers can do to assist employees in becoming wise, health literate consumers:

  1. Develop and disseminate health and safety information that is accurate, accessible and actionable.
  2. Promote changes in the health care system that improve health information, communication, informed decision-making, and access to health services.
  3. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula into employee education.
  4. Support and expand organizational and local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services.
  5. Build partnerships with health plans, communities and providers, develop guidance for consumers, and change policies to reward health literacy initiatives.
  6. Increase basic research and the development, implementation and evaluation of practices and interventions to improve health literacy.
  7. Increase the dissemination and use of evidence-based health literacy practices and interventions.

Beyond Choosing Wisely

“One-third of health care does nothing to improve health: It does not lengthen life, it does not ease suffering. It’s waste. Overtreatment wastes approximately $800 billion a year.”
Shannon Brownlee
Author of “Over-Treated”

Minnesota Health Action Group Members may not even be aware of the complimentary and customizable communication toolkits and purchaser guides that are available to help ease the burden of communicating with employees. I also invite you to visit the Engagement section of the website, which features a video and consumer communications and education materials.

In addition, there are some great resources available through the Center for Health Care Strategies, such as Improving Print Communication to Promote Health Literacy.

Consumer Reports campaigns that complement Choosing Wisely include:

Employers and consumers have ready access to materials from Consumer Reports. They offer more than 100 plain English and Spanish pamphlets, customized web pages, posters, videos, social media campaigns, and events related to the Choosing Wisely campaign, which is summarized here.

No Clear-cut Answers…But a Path to Better Understanding

During a recent recurrence of my condition, my doctor was again insisting on a CT, attempting to convince me that the risk of over-use of antibiotics outweighed the risks of a fourth scan. This time, I was armed with the Choosing Wisely Fact Sheet, sponsored by the American Gastroenterological Society, and links to over 20 sites—from WebMD, to Mayo Clinic, to Harvard Health—confirming that combining dietary changes with antibiotic therapy is the preferred first line of defense.

Two antibiotics and two weeks later, I was as good as new and avoided unnecessary radiation risk—and a hefty expense of nearly $1,000. I also took extra time to call four pharmacies to compare prices, and was shocked that they ranged from $7.50 to nearly $90!

I’m not sure my doctor was utterly pleased with my uncharacteristically assertive behavior…I just know I’m glad to be feeling well…and feeling more confident in my ability to have constructive, two-way conversations about my health and health care.

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