Christine Laine, MD, MPH, Editor in Chief
Laine C.; High-Value Testing Begins With a Few Simple Questions. Ann Intern Med. 2012;156:162-163. doi: 10.7326/0003-4819-156-2-201201170-00016
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Published: Ann Intern Med. 2012;156(2):162-163.
In light of escalating health care costs and recognition that too large a proportion of care provides little or no benefit to patients, the American College of Physicians (ACP) convened a workgroup of physicians to identify common clinical situations in which the use of tests fails to provide high-value, cost-conscious care. The ACP defines high-value, cost-conscious care as delivery of services that provide benefits commensurate with their cost and that outweigh any associated harm (1-2). Value is not merely cost. An expensive test that alters care and outcome in a positive way is of greater value than a cheap one that does not. This issue includes a commentary that presents 37 testing scenarios that the ACP workgroup believes provide little or no value to the patient (3). Undoubtedly, physicians, their patients, and others with a stake in health care will take issue with at least some of the items on this consensus-based list. Some readers might object to its very existence. Others might argue that the list is too short.
Laraine, Crampton, Acupuncture, Traditional Chinese Medicine
January 17, 2012
I believe that we need to have clear standards for what the best raw resources are in herbal medicine (has a particular herb been harvested in the right manner, in the right season, under the right conditions?), and for appropriate and safe processing for optimum quality of the end product.
However, I believe the rush towards 'standardization', if applied to having an array of 'standard' products along the lines of the 'patent medicines' traditional in China, can be an expensive distraction from our true responsibility to provide a flexible pharmacopia for individual, custom, application--so that each patient receives the formula that is precise to their condition. Otherwise, we end up using a lot of herbs unnecessarily, and throwing our efforts into providing 'patents' that are perhaps close to useful but achieve only partial results, when true remedies might have been provided.
The planet is not endlessly able to provide unlimited resources of herbs if we go mindlessly into big pharma approaches for our natural medicines.
mary, rappazzo, MD
January 23, 2012
A question to ask is would an adequate history and physical answer the problem without further testing
Also ,am I more apt to order a test because of financial incentive ex. ultrasound,scan,lab etc in the office
How do I as an internist control overtesting by specialist and NPs,PAs and Hospitalists
That being said this article and the message it sends should be a major theme for ACP and we not only need to educate ourselves about this factor in cost escalation but our patients as well.
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