HLM: It occurs to me that in the effort to keep costs down, we have an even bigger effort with multiple specialties involved in the American Board of Internal Medicine's "Choosing Wisely" campaign. How is that impacting the internal medicine doctor's practice? I imagine that doctors might be spending as much time talking patients out of getting worthless care that might do harm as they do talking patients into doing something, or having something done where there's evidence it can help them.
DB: Yes absolutely. I think there's a responsibility to help patients understand when something is not useful, like a test. Or even when something might cause potential harm. We have an ethical responsibility.
HLM: Hasn't that always been the case? What's changed?
DB: We have always had the responsibility, but now it's affecting the bottom line, for example, in an ACO, or whatever structural organization you might have for shared savings. We want patients to get the right care at the right time, and no more than necessary. I think there's a shift in thinking on this issue. There's a lot more realization we have to be prudent with resources. We have to get rid of the things that add no value in healthcare.
The payers are paying attention to this too. They're saying no when there's no indication for a screening test.
I don't recommend some of the tests I used to recommend, also, because science has come along and said, gee, we thought that was more useful than it ended up actually being. The PSA (prostate specific antigen) test for prostate cancer is one example.