Low-value Care Misunderstood By Patients

Tinker Ready, April 6, 2017

A Yale study finds that while patients have difficulty envisioning the benefits of avoiding low-value care, they are clear on one point: They would like doctors to spend more time talking and less time testing.

Mark Schlesinger, PhD
Mark Schlesinger, PhD

Choosing Wisely has become a healthcare call-to-action not unlike the "triple aim" and, increasingly, "measures that matter."

The doctor-driven campaign to reduce the use of unnecessary care needs to reach two audiences, doctors and patients. Its message to doctors: Think twice before ordering that test or starting that treatment. Its message to patients is less clear, according to a study out of Yale.

The Yale study cites the Choosing Wisely campaign throughout, but its aim was to look, not at that program specifically, but at how well the public understands the concept of low-value care.

The paper found one-third of those surveyed "have difficulty envisioning benefits from avoiding low-value care."


Unwise Medical Choices Stubbornly Defy Eradication


Mark Schlesinger, a professor of health policy at the Yale University School of Public Health, is the lead author of the study. He lauds the American Board of Internal Medicine, which launched and shepherds the Choosing Wisely campaign, but says ABIM has "a hard message to communicate."

The study, which appeared in the Millbank Quarterly, involved focus groups, interviews and a national survey of more than 900 people. They were asked questions such as this:

"People will sometimes talk about doctors being especially good at avoiding tests and treatments that are likely to have more risk than benefit. If you were to hear or read that a particular doctor was good at this, what—if anything—would you expect them to do differently from most other doctors?"

The researchers found that two-thirds of those surveyed "had some sense of what low-value care might entail, though many were uncertain about the specifics." Additionally:

  • Many who offered a description of low-value care saw it in terms of only testing, not treatment.
  • About 5% "anticipated that excessive medical care might harm patients."
  • About 1% made a link between low-value care and medical costs – either their own or the nation's.
Tinker Ready

Tinker Ready is a contributing writer at HealthLeaders Media.

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