But some physician groups are taking the checklist premise one step further, focusing on procedures that should be minimized or eliminated altogether.
One of the key proponents of such lists of wasted practices is Howard Brody, MD, at the Institute for Medical Humanities at the University of Texas Medical Branch at Galveston. “The myth that physicians are innocent bystanders merely watching health care costs zoom out of control cannot be sustained,” Brody wrote last year in the New England Journal of Medicine.
Brody suggests that each specialty society appoint blue-ribbon panels to create “top five” lists of diagnostic tests or treatments that are among the most expensive and generally do not provide much benefit.
Nancy Morioka-Douglas, MD, MPH, a clinical professor of medicine/community and family medicine at the Stanford University Medical School, and a member of the NPA, agrees that doctors must take control of costs, especially needless procedures.
Referring to Brody’s plan, Morioka-Douglas seeks a “call to action” among each medical specialty to generate lists of at least the top five commonly ordered diagnostic tests or treatments that provide “care of low value to patients, specifically if it carries risk that outweighs benefits.”
The NPA convened a Good Stewardship Working Group to identify overused clinical activities across three primary care specialties, internal medicine, and family practice.