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July 10, 2013
In rural Maine, Choosing Wisely brought primary care and specialists together to discuss the recommendations – a positive, unintended consequence of the campaign.
Early in the development of the campaign, we learned that physicians did a lot of finger-pointing around who was responsible for overuse. The primary care physicians blamed the specialists and the specialists blamed the primary care physicians. As reported to me by a chief medical officer of a Maine-area health system, the silos that currently hamper communication between primary care and specialists didn’t exist in the good old days. To remedy the current situation, the health system hosts “block parties” where a group of around 20 primary care physicians—made of up physicians from the hospital, federally qualified health centers, private practices and residents—invite particular specialists to talk about how their area of expertise and how their service is delivered. This socialization forges better relationships among these diverse physicians.
The Choosing Wisely recommendations were the focus of many of these “block parties.” The conversations have since migrated to what five things they, as a group, can do better. They discussed developing a mutually acceptable set of protocols that will guide a mutual understanding of treating a particular patient. This could include order sets, gentle guidelines and recommendations on overused tests and procedures.
The “block parties” are important conversations about mutual expectations and agreements about shared care of patients. Equipped with recommendations from specialty societies based on the best medical evidence, specialists and primary care physicians can find common ground and the focus of the conversation can be what is best for the patient. Something as simple as these “block parties” can be easily adopted by others and be the basis for changing how care is delivered. Who would have thought that better communication between primary care and specialty care would be an outcome of Choosing Wisely? Some wise Mainers did!
Daniel B. Wolfson
EVP and COO, ABIM Foundation