Where's Endocrinology in 'Choosing Wisely'?
Richard M. Plotzker, MD
In a scene from Amadeus, Salieri -- the competent but ordinary music director -- critiques an elegant composition by the crude genius Mozart, observing that it has "too many notes." Mozart immediately retorts that his music has just the right number of notes for its purpose.
As we order medical tests and therapies for patients, most of us regard what we do as purposeful and generally necessary, if only to keep the lawyers a safe distance away but also to avoid missing anything of medical significance. As a consequence of this sincere effort to be thorough, we often drive up costs for treatments that may contribute little to our patients' well-being.
A recent report from the Choosing Wisely campaign identified almost 90 common but often unnecessary medical tests and procedures. Many of these items involved imaging studies that could be eliminated in patients whose history put them at low risk and whose exams were normal. Unfortunately, history taking and meticulous examinations appear to be waning in medical training. It may be difficult to win this battle in a setting such as the emergency department, for example, where imaging is often a surrogate for bedside clinical analysis.
Conspicuously absent among the Choosing Wisely recommendations were any devoted to endocrinology. The Endocrine Society is a partner of Choosing Wisely and is spearheading the development of an endocrine-specific list in conjunction with the American Association of Clinical Endocrinologists. At this time, however, among the report's 90 recommendations, the only one unique to endocrinology came from the Nuclear Medicine people to limit 123I uptake and scans to people with hyperthyroidism.
So, may I address 5 common things that physicians do with endocrine patients that add to costs without improving patient care? With the disclaimer that I represent no organization, I'll pay my quarter and take a shot.