December is "Greatest HIts" month here at Quizzify. Every day, we will be reposting one of our most popular blogs, starting with this one.
Choosing Wisely is a joint campaign by many medical societies and Consumer Reports to educate doctors on avoiding questionable medical tests, treatments and procedures. As a third of healthcare spending in the U.S. likely wasted, this campaign is both welcome and needed.
While we support Choosing Wisely’s recommendations (and often link to them), an article in Health Affairs this week reveals that its results have been disappointing:
Only 25% of physicians are aware of the campaign.
More importantly, of that quarter, 87% admit to continuing to order tests they know are unnecessary.
Education should be aimed at consumers, not suppliers, of healthcare
Here's why it has failed. It targets the wrong audience—the supplier, not the consumer. Consider:
Rachel Carson initially wrote to Monsanto to urge them to stop making DDT before going straight to the public with her environmental blockbuster, Silent Spring.
Ralph Nader pestered auto executives for years to invest in safer cars before going straight to the public with Unsafe at Any Speed.
In both cases, the initial path of asking producers to lose money by doing right, failed. Likewise, in healthcare, Rick Scott, formerly CEO of HCA and Governor of Florida, famously said: “Show me any industry willing to cut its own revenues in half.”
Indeed, useless and possibly unsafe healthcare is no different from pesticides or unsafe cars: spending on useless or unsafe care won’t change until the market forces a change. In this case, the “market” is the employees who demand unnecessary care (or acquiesce in it) and the employers who enable them.
So far, this “market” has also failed. “Healthcare consumerism,” described as “empowering” consumers to make their own choices by shifting costs to them, can work only if consumers know how to choose. They need to ask questions, question answers, and feel confident in saying “no thanks,” when it is appropriate to do so.
And that’s the missing link in Choosing Wisely. Even though one of its goals is “spurring conversations” about what is necessary and appropriate treatment, it assumes the doctor will start the conversation. They don’t.
And consumers don't even realize there is a converation to start.
Consider CT scans. Americans consume those at a rate twice as high as other developed countries. They pose hazards: considerable radiation, dye that may cause kidney problems, and the possibility of finding abnormal but clinically inconsequential problems that are so common they even have a name—“incidentalomas.” These are all “costs” to be weighed against the benefit. But the cost-benefit conversation can’t start unless the employee/consumer already knows to ask the relevant question. When was the last time a doctor started a conversation with you about those risks?
Employees must start these conversations, which means employees have to know what to ask. And that’s where Quizzify comes in. It’s up to the end users—you and your employees—to ask the right questions and make the right decisions, when it comes to medical care. Quizzify’s mission is to help your employees become competent medical care consumers through education.
We don’t tell employees what to do, explicitly. That never works. Instead, We plant the seeds of questions about medical tests, treatments or other health care decisions, by turning health information into trivia games that are as educational as they are enjoyable, with questions reviewed by doctors on staff at Harvard Medical School.
Don’t take our word for this. Play the sample game now, and see what you you