Bloomberg op-ed: Keep doctors, not hospitals, in charge of patient care

Shannon Brownlee and Vikas Saini of the Lown Institute have an op-ed posted at Bloomberg View today. It points out that when hospitals purchase large physician groups, they usually raise prices – but there’s not much evidence that care gets any better. Collaboration between clinicians is important, but it requires leadership and a desire to organize care to benefit patients – not just the formal structure of an integrated practice.

The key quote:

“If we want better care and less waste, the balance of control over what happens to patients should be in the hands of physicians, not hospitals.”

Check it out!

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Quick follow-up on mammography

This morning, Shannon Brownlee went on the Diane Rehm Show to discuss the RCT published in the BMJ showing no mortality benefit to screening mammography. If you weren’t able to catch the show this morning, you can listen to the show here.

Also, Dr. Aaron Carroll, blogger at The Incidental Economist, has a fantastic post that responds to a lot of the arguments against the study that came up on the radio show. His last paragraph sums up the debate perfectly:

“I leave you with one final thought. If you’re not going to be swayed at all by a randomized controlled trial of 90,000 women with 25 year follow up, excellent compliance, and damn good methods , it might be time to consider that there’s really no study at all that will make you change your mind.”

 

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Long-term study shows screening mammography doesn’t reduce mortality.

Yesterday, a Canadian study group published the final follow-up results of a long-term randomized controlled trial in the BMJ, showing that screening mammography had no mortality benefit for middle-aged women, and that screening has the potential to cause substantial harm.

The study, which shows that mammography offered no more benefit than physical breast examinations, but overdiagnosed breast cancer in a number of women, is in line with other studies showing that screening mammography does not reduce mortality, and that breast cancer is commonly overdiagnosed and overtreated.

Women who are considering getting screened need to understand the possibility of overdiagnosis, and the potential harm from being treated unnecessarily, especially in a medical environment that heavily promotes such tests as the only responsible way to manage one’s health.

Read more at the New York Times and The Incidental Economist.

For press inquiries, please email info@lowninstitute.org, or tweet at us @lowninstitute!

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The videos are here!

These are the first videos from the 2013 Lown Conference, covering the four keynote speakers: Dr. Don Berwick, Dr. Iona Heath, Rabbi Richard Address, and Dr. Bernard Lown. We recorded the whole conference, and there will be many more videos coming, so stay tuned.

We hope those of you who came to the conference will take the opportunity to revisit some of the high points of the meeting, and that you’ll share these videos with your colleagues. If you weren’t able to attend the meeting, this is your opportunity to get just a taste of what the conference was like!

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Why a Declaration? Because we need a movement.

By Vikas Saini, MD, and Shannon Brownlee, MS

The Right Care Alliance is a movement of clinicians, patient advocates, community leaders, and patients who see that overtesting, overdiagnosis, and overtreatment are endemic to modern health care – they are built into the culture of modern medicine. We see overuse as the flip side of the coin of undertreatment and lack of access, and a major cause of harm to patients.

The movement grew out of the Avoiding Avoidable Care conference, which we convened April 2012. When we started planning a conference on overuse, we knew we had a lot to learn from the participants in the meeting about specific research findings, pilot programs, and best practices. But until the conference, we didn’t fully understand the power and importance of coming together, to share our concern about practices that harm patients, and our belief in the moral necessity of working together to reduce overuse. For many participants, the 2012 conference showed them that they were not alone. It was a powerful realization, and it was coupled with a rising conviction that the conference had to be more than a one-time event. The power of the group, and of convening around a shared vision of what medicine could be and should be, meant we needed to keep moving forward: we needed a movement.

The Declaration of Principles of the Right Care Alliance

Whereas:

  • Modern medicine offers important benefits, yet it also has the capacity to cause harm;
  • Those harms arise from three central failings of medical systems: the overuse, underuse, and misuse of medical services. Of these, overuse – including overdiagnosis, overtreatment, and the use of ineffective, unnecessary, and unwanted medical tests and treatments – has received the least attention;
  • Overuse is common and tacitly accepted in modern health care;
  • Overuse exposes patients to harm, including the risk of serious injury or death, suffering, and financial ruin, with little or no possibility of benefit;
  • Overuse diverts resources from the provision of needed care, and crowds out investment in social services, education, nutrition, and other non-medical contributors to health;
  • The health care industry puts money before people and allows personal and commercial interests to distort clinical decisions, thus betraying patients’ trust;
  • Clinicians and health care leaders have an ethical obligation to protect patients from the harms of both underuse and overuse;

Therefore we, the signatories of this document, declare that performing unnecessary medical tests and treatments is unethical and unacceptable. We join the call for the medical profession to renew its sense of duty and commitment to patients. We call on health care leaders to recognize their ethical obligation to put patient care first. We call on civil society to advocate for a medical system that is affordable, effective, rational, personal, and just.

Our vision:

A more just and compassionate world where health and health care are basic rights. where patients are safe from unnecessary diagnosis, treatment, and harm. where patients’ wishes are respected by their caregivers. where clinicians serve as healers, and as advocates for those who are most vulnerable and in need of care. and where health care exists for the benefit of patients, communities and nations.

Our mission:

We, the signatories of this document, seek to foster a new social contract between civil society, the profession of medicine, and the business of health care. We will promote the creation, dissemination, and execution of this new covenant through community and professional organizing, convening, original research, public policy, public speaking, and writing.

We believe:

  • the delivery of medical care is a moral enterprise that begins with the bond between clinician and patient.
  • the profession of medicine is a calling, distinct from the business of health care.
  • every person deserves access to effective, humane, and affordable health care.
  • good medicine requires valid, unbiased science.
  • medicine exists to ease human suffering and promote the health of individuals and communities. health care must be reorganized to fulfill this mission.

In a transformed health system, patients can expect to:

  • have access to the care they need
  • be able to advocate for care that better meets their needs
  • be safe from unnecessary treatment and needless harm
  • feel cared for as whole persons
  • be protected from commercial interests
  • be informed and involved in choices about their treatment

In a transformed system, clinicians can expect to:

  • have the time they need to care for their patients
  • make clinical judgments in the best interests of their patients
  • be free from undue worry about litigation
  • feel supported in their efforts to improve care
  • feel confident in the science that supports their decisions
  • feel proud of their profession and privileged to serve patients

Our pledge:

We, the clinicians, patients, and others who sign this document, commit to support the best care possible. We clinicians accept the ethical obligation always to put patients’ needs first. We acknowledge that there are limits to our collective knowledge and power to cure. We agree to spread our sense of this obligation. We recognize the power we have gained through our training and status as clinicians, and accept our responsibility to engage our patients, learn their preferences, and share treatment decisions. As patients, we recognize our power to spur change with our collective voices.

Together, we choose to take action because we know the current system is neither morally nor economically sustainable. To this declaration and its principles, we pledge our energy, our skills, and our voices.

Sign the Declaration here.

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Apply for a scholarship to the 2013 Lown Conference!

We are excited to announce that we have scholarship funding to help bring  medical students, residents, nurses and nursing students, community organizers, civic leaders, patients, and patient advocates to the 2013 Lown Conference – apply now

The conference is happening on Boston on December 3rd and 4th. You should read the full program, but here’s a refresher on the major goals of this year’s conference:

  • Creating a new conversation among clinicians, patients, and civil society about the purpose of medicine and the health care system
  • Understanding overuse as a moral and spiritual problem
  • Recognizing that a better world is possible
  • Envisioning health and health care 25 years from now.

We will also have working group meetings on December 5, the day after the conference, covering Medical Education, Public Engagement, International Collaboration, the Choosing Wisely campaign, and Setting the Research Agenda. If you are interested in participating in one of these working groups, please email us for more information at info@lowninstitute.org, and watch this blog for more details on the different working group agendas!

If all of that sounds exciting and informative, but you’re unsure of how to pay for travel, this is your opportunity! The scholarships will provide reimbursement (up to $1200) to cover travel and lodging for the conference. We are committed to using these scholarships to bring a wide range of voices and perspectives to the conference, and we know it will be a better event with representation from all groups concerned with reducing overuse in medicine.

If you’re interested, apply here by 5pm Eastern time on November 1, 2013. (That’s only two weeks from tomorrow!) We are only able to offer a limited number of scholarships, but will accommodate as many applicants as possible. We will notify recipients by email.  

And finally, please share this information with your colleagues, students, and anyone else who you think would benefit from participation in what promises to be an incredible conference!

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