"Choosing Wisely"

reprinted from Issue 14, Spring 2012 of Frontiers of Medicine (PDF)

Talmadge E. King, Jr., MD

When I was training to become a doctor, the mantra I grew up with was that our job wasn’t to worry about what things cost – we were supposed to do everything to help our patients. It turns out that much of that approach is probably wrong.

The Congressional Budget Office estimates that up to 30 percent of care delivered in the United States goes toward unnecessary tests, hospitalizations and other services that may not improve patients’ health, and may actually cause harm. Doing what is best for our patient does not always mean ordering every possible medication, test or procedure that may be available..

Our role as doctors has changed since I entered the field. We have a responsibility to help patients choose care that is supported by the best evidence, showing that it is effective for patients like them. We also have a larger responsibility to think about the health of the entire community – including vulnerable and underserved patients – as well as the patient in front of us. Often, we can achieve the same or even improved outcomes, if we make wise choices and develop better ways of practicing medicine.

As Molly Cooke, MD, William G. Irwin Endowed Chair and director of the Academy of Medical Educators, wrote in a recent New England Journal of Medicine article, “We are stewards of … ‘the medical commons.’… Educating physicians to be cost aware is a critical responsibility of medical schools and residency programs.”

As several stories in this issue illustrate, UCSF is a leader in this effort:

  • Faculty at San Francisco General Hospital and Ocean Park Health Center have piloted programs that employ an effective, easy-to-use test that can potentially help screen many more people for colorectal cancer than colonoscopy alone.
  • Researchers at the San Francisco Veterans Affairs Medical Center have made important discoveries about which mammography screening protocols are most likely to maximize benefit while minimizing harm.
  • A multidisciplinary initiative at UCSF Medical Center has reduced 30-day readmissions of heart failure patients by almost half.
  • Our residents and faculty at UCSF Medical Center and SFGH have developed educational materials to provide information about cost and radiation exposures for commonly ordered radiology

Last summer, a number of UCSF faculty and I attended a conference sponsored by the American Board of Internal Medicine Foundation entitled “Choosing Wisely: The Responsibility of Physicians, Patients and the Health Care Community in Building a Sustainable System.” UCSF was one of the most well-represented institutions at the conference. We are proud that the Department of Medicine has so many faculty members who are pioneering ways to improve quality of care while lowering costs, and we thank you for your support of these efforts.


Talmadge E. King, Jr., MD
Chair, Department of Medicine
Julius R. Krevans Distinguished Professorship in Internal Medicine

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