Medical Chronicle November/December 2013 | Page 15

NEWS

CHOOSING WISELY
There is a crucial question that South African doctors in the private sector will have to start
considering. How can they ensure the appropriate use of tests, procedures and drugs to the
benefit of the patient, profession and the sustainability of the health system as a whole?
In the US, this engagement is already
taking place through the Choosing
Wisely campaign, a doctor-driven
initiative led by the American Board
of Internal Medicine and professional
societies that aims to eliminate
unnecessary and wasteful services
that have in many ways become
entrenched in clinical practice for the
wrong reasons.
Concerned about the impact of a
rapidly changing, commercialised
landscape of healthcare on medical
professionalism, doctors in the
US have joined forces with their
European counterparts to define a
Physician Charter. This charter aims
to reaffirm doctors’ commitment to
individual patient welfare, as well
as the basic tenets of social justice.
Included among others is the will
to promote the just distribution of
scarce resources, improve patient
access to care, manage potential
conflicts of interest appropriately
and base clinical practice on sound
scientific evidence. ‘Choosing Wisely’,
an educational campaign, was born
from this pledge.
Each of the participating clinical
societies had to identify five tests,
practices or procedures in their
specialties that were not really
contributing to the improvement of
patient care, or in fact undermining
best patient outcomes.

patient expectations. In the US,
practices identified to be wasteful
and/or harmful by specialist groups
are published and communicated
to healthcare professionals, as well

as the broader public via consumer
organisations. This is in an effort to
encourage open discussion between
patients and doctors.
The first step to address these

Dr Bettina Taylor, Head of Health
Policy at Medscheme

challenges is for the focus to shift
back to what is best for the patient and
for doctors to get their professional
independence back to make these
decisions, said Dr Taylor.

The SA situation
In SA, poor quality of care tends
to be blamed on under-servicing,
as experienced in many parts of
the public sector due to resource
constraints. Medical funders are
also often blamed by healthcare
professionals and patients, for poor
quality outcomes given withholding
of benefits. “The harmful effects of
over-servicing remain glossed over
though,” said Dr Bettina Taylor, Head
of Health Policy at Medscheme.
“Many established practices cannot
fulfil the promises they make, cause
more harm than good and drain
the system of valuable resources
unnecessarily.”
It is the Choosing Wisely campaign
that some medical schemes in SA are
hoping will inspire local professional
societies and their leadership to
go the same route in their quest to
improve patient care and rein in the
cost of excessive care and expensive
interventions, driven by habit,
conflicting interests and unrealistic
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