Many interventions patients request, such as antibiotics for common colds or routine prostate-specific antigen screening for prostate cancer, either do not provide net health benefits or provide no more benefits than less risky or less harmful alternatives. This is the basis for the “Choosing Wisely” campaign promoted by the American Academy of Family Physicians and more than 70 other health care organizations.
Helping your patients choose wisely when it comes to medical interventions can be challenging, but three strategies can help:
• Know the evidence. Familiarize yourself with not only the Choosing Wisely recommendations but also the evidence behind them. Three good sources for this are the AAFP’s Choosing Wisely resources, American Family Physician’s Choosing Wisely database, and the Agency for Healthcare Research and Quality’s Effective Health Care Program.
• Help patients make informed decisions. To understand why patients want a questionable test or treatment, use motivational interviewing techniques, such as asking open-ended questions, using statements of affirmation, practicing reflective listening, and summarizing important elements of the discussion. Ask what concerns them the most and validate those concerns, pay attention to nonverbal cues indicating distress or confusion, avoid using medical jargon, and refer to the relevant guidelines – while acknowledging each patient’s unique situation.
• Build (and lead) the system. You can do this by discussing unnecessary interventions during monthly meetings with medical directors and practice leaders, using the Choosing Wisely recommendations as the basis for quality improvement projects, and advocating for technology that provides reminders and evidence-based order sets that improve your ability to provide effective care.
Adapted from "How to Help Your Patients Choose Wisely."
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