You know your body, you’re in charge of it

By most objective standards, healthcare costs in the United States are higher than anywhere else in the developed world, yet outcomes – what our healthcare dollars actually are able to buy for us – are, relative to the rest of the world, pretty dismal. However we pay for our healthcare – whether directly from our own pockets, with private insurance, with Medicare, or with some combination of all of the above, virtually no one disputes that the costs are too high.

One important initiative is Maine Choosing Wisely, a program sponsored by the American Board of Internal Medicine, and Consumer Reports. The program is administered in Maine by Maine Quality Counts , a partnership between patients, communities, healthcare providers and others collaborating to improve healthcare practices and outcomes statewide.

The MCW coalition is comprised of more than four dozen partner organizations including most healthcare providers and major state-wide health and human rights non-profit organizations. The expressed purpose of this program is “to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices.”

The way it works could not be simpler: It’s all intended to give each of us a more prominent role in choosing our own healthcare solutions, to be more pro-active and more responsible for our own well-being. We are being encouraged to ask questions, and are being provided with more resources with which to be well informed.

“Despite that,” said Dr. Lisa Letourneau, M.D., MPH, executive director of Quality Counts, “we know that this questioning does not happen the majority of the time. Patients – particularly older adults – often report feeling unprepared and unwilling to challenge the perceived ‘authority’ of their physician. They express understandable concerns that such questions could appear disrespectful, or could cause their doctor to view them as ‘difficult.'”

Associations representing most specialty healthcare practitioners have identified all sorts of tests and procedures that are often ordered by doctors or requested by patients, but which are sometimes unnecessary, redundant, potentially harmful, and which help drive up the cost of more meaningful care. Some such procedures have been mandated by insurance requirements, by an over abundance of caution, or for other originally good reasons, but usage has come to exceed effectiveness.

“So in the face of these challenges,” said Letourneau, “how can we expect even very well-intended efforts such as Choosing Wisely to work? The answer is first and foremost about creating culture change – i.e. we must, as physicians, actively invite questions, make time, and give permission for patients and families to ask questions and challenge recommendations, and be proactively attentive to issues of cost and affordability.”

The unique Choosing Wisely coalition of doctors, medical facilities and practices, patients and patient advocacy groups believes that as individuals we have the biggest role to play in our own healthcare and that by becoming proactively engaged with our doctors and other healthcare providers, we can all live healthier lives and help reduce the costs of care in the process.

The relationship between patients and providers should start with a dialogue focused on five vital questions:

1. Do I really need this test or procedure? Medical tests help you and your doctor decide how to treat a problem, and medical procedures help treat them. But some of these could be redundant if they’re done too often. There may be less intrusive ways to diagnose or treat medical issues than any individual test or procedure.

2. What are the risks? Could there be side effects? Is there a chance of getting inaccurate results? Could the consequences be still more testing or additional procedures?

3. Are there simpler, safer options? Sometimes lifestyle changes, such as eating healthier foods or exercising more can do more for our health. Most people now recognize, for example, that taking an antibiotic to treat a common cold not only doesn’t work, but it could help build resistance to antibiotics in ways which could become dangerous when we really need them.

4. What happens if I don’t do anything? Simply asking if your condition might get worse – or better, for that matter – if you don’t have a test or procedure right away might lead to some surprising choices.

5. How much does it cost? Ask if there are less expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs that are just as effective but much less expensive.

Now after you have this conversation, you and your doctor might well decide to continue with the test or procedure, but you might also choose an alternative. The important consideration is that it’s all about helping you make the smartest choices about your own healthcare. Maine Choosing Wisely has all sorts of resources to help you make informed decisions, in cooperation with your healthcare professionals, and you can find lots more information at: