Mark Thill
Choosing Wisely
Do not:
- Routinely perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because these tests do not improve survival.
- Routinely order expanded lipid panels (particle sizing, nuclear magnetic resonance) as screening tests for cardiovascular disease.
- Test for amylase in cases of suspected acute pancreatitis. Instead, test for lipase.
- Request serology for H. pylori. Use the stool antigen or breath tests instead.
- Perform fluorescence in situ hybridization (FISH) for myelodyplastic syndrome (MDS)-related abnormalities on bone marrow samples obtained for cytopenias when an adequate conventional karyotype is obtained.
Got that?
Doctors’ orders
They say that the majority of healthcare procedures and costs stem from doctors’ orders. That’s called utilization of resources, and it’s something over which supply chain executives ultimately have little control.
Yes, we’re told supply chain executives can and should tackle utilization. But really, are you going to make a case as to why the doctor shouldn’t perform fluorescence in situ hybridization (FISH) for myelodyplastic syndrome-related abnormalities when an adequate conventional karyotype is obtained? Good luck with that.
The only ones who can really affect utilization are doctors and clinicians – those who order tests and perform procedures. The good news is, they are increasingly buying into the notion that they not only must work to treat and prevent disease, but they must also be responsible stewards of healthcare resources. That means avoiding tests and procedures that have no value to the patient, and that means reducing utilization.
Identifying such tests and procedures is the mission of the ABIM Foundation’s “Choosing Wisely” campaign, about which we’ve written before. To date, more than 70 specialty societies have released recommendations with the intention of facilitating wise decisions about the most appropriate care based on the individual patient’s situation. (The list of five “Don’t” above are recommendations published in September by the American Society of Clinical Pathology.)
These are challenging times for supply chain executives, whose organizations are more complex and cost-conscious than ever. But look at the bright side: For the first time, you have buy-in from the medical/surgical side of the aisle. Successful supply chain executives will use it wisely.
For more information on Choosing Wisely, go to www.choosingwisely.org.