Finger pointing rife when it comes to ‘do-not-do’ lists

Medical politics

By Tessa Hoffman

7 Jun 2018

Researchers say they have uncovered a culture of “interdisciplinary finger pointing” within the international Choosing Wisely movement, as medical groups close ranks in an effort to protect their members’ interests.

The researchers, from the department of Musculoskeletal Health at the University of Sydney, analysed 1265 recommendations under the Choosing Wisely banner, including 177 from Australia.

In preliminary findings, they identified that almost two thirds of the recommendations made by professional bodies which relate to an income generating procedure, such as a surgical intervention, were directed at clinicians from other specialties.

“For example, we saw the American Medical Society for Sports Medicine publishing recommendations for avoiding knee arthroscopy which is typically a procedure done by surgeons and we had nursing academies publishing recommendations about not prescribing opioids”, said lead researcher Dr Joshua Zadro (PhD) who presented the findings in a poster at last month’s Choosing Wisely national meeting in Canberra.

“We noticed there was a lot of what we termed as finger pointing going on,” Dr Zadro told the limbic. 

This trend has serious implications, with the potential to drive duplication but also gaps, he said, noting how a recommendation against imaging for back pain was made not only by the Royal Australian and New Zealand College of Radiologists, but also two surgical societies, several physician societies and the Australian Physiotherapy Association.

Meanwhile, despite research showing that knee arthroscopy is ineffective compared to sham surgery for knee osteoarthritis “no surgical society within Australia or America is willing to make that recommendation in Choosing Wisely”, he said. “Without that, potentially clinicians are still going to advise their patients to go ahead with this procedure.”

There is a need to delve further into the reasons why societies are pointing the finger, rather than taking on their own memberships.

But Dr Zadro suggested a desire by societies to protect their members’ incomes was a likely driver.

“If clinicians are making a living off performing certain treatments, there might be some reservations as to recommending against these procedures, and it might be a lot easier for societies to recommend against non-income generating treatments, or potentially just recommend against diagnostic tests that different societies do.

“This way they could fill up their list of Choosing Wisely recommendations but not impact the income of their members”.

“I think the findings of our study could suggest that there are societies who aren’t making these recommendations, and in terms of implications it could suggest they need to be more aware to target members. ”

Moving forward, the research could point to a need for the Choosing Wisely campaign to impose requirements for societies to target their own members.

“It’s not that the concept of finger-pointing is extremely detrimental in Choosing Wisely, because at the end of the day the majority of the recommendations are to improve patient care and whether they are coming from different societies, in themselves they will still increase discussions about low value tests and treatments.

“But I just think we could improve the coverage of these recommendations if individual societies targeted their own members first, and then targeted non- members (if necessary).”

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