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Hello and welcome. I am Dr. George Lundberg, at large for Medscape.

In about 1989, then-Secretary of Health and Human Services of the US government Dr. Louis Sullivan stated that between 30% and 40% of American medical care was unnecessary, wasted, or inappropriate. In 2013, Massachusetts health dignitaries stated that 30% of medical care in Massachusetts is unnecessary or inappropriate.

If they are correct, why have we in the American medical profession not fixed that in more than 20 years? Could it be that generation after generation of people who populate the system simply like it the way it is -- veritable pigs addicted to the money trough?

Many within the system have spoken out about this problem. Few dispute that it is a problem, but few have produced plans to stop the waste. And no plans have succeeded.

What to do?

In 2010, writing in the New England Journal of Medicine, Howard Brody pointed the way.[1] He called for medical societies to take the lead in the country's best interests by identifying 5 medical actions in the sphere of their specialty practices that were invalid or questionable, and to ask their members to stop doing them. As President of the American Board of Internal Medicine, Christine Cassel picked up this challenge and opportunity, and the ABIM Foundation took ownership of this concept and created the Choosing Wisely® campaign.

Following their lead, the Lown Institute in Cambridge, Massachusetts, held a conference called "Avoiding Avoidable Care" in early 2012. Recent studies have demonstrated that improper care is overutilized more than proper care is underutilized. As a result of the Lown Institute conference called From Avoidable Care to Right Care in late 2013, the concept evolved.

Ladies and gentlemen, we have a movement with momentum. Joining the Choosing Wisely initiative, more than 60 medical societies have now identified more than 200 medical actions that should be questioned, and the elimination of which can provide lower costs and better quality care. Consider some of the examples, believed by insiders to be important common actions that need to be considered for elimination:

The American Society for Clinical Pathology: Do not use bleeding time tests to guide patient care.

The American Academy of Family Physicians: Do not order annual ECGs or any other cardiac screening for low-risk patients without symptoms.

The American College of Physicians: Do not obtain imaging studies in patients with nonspecific low back pain.

There are hundreds more, but you get the flavor. Most make common sense. Frankly, most lab tests and imaging studies do not need to be done. The results are either negative or normal, show no change from the previous studies, or provide no actionable information.

Is this movement going to make a difference? Too soon to tell. It depends on market penetration. Sad to say, physicians tend to not change their behavior unless money is involved -- more or less. But many of us are hopeful that the medical professionalism of physicians comes to the fore in response to the medical professionalism being demonstrated by their societies, and that physicians en masse wisely choose the right care.

That's my opinion. I am Dr. George Lundberg, at large for Medscape.


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