Choosing Wisely makes me Happy

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. He blogs at Senior Moments and tweets at @sean9n and @gerisregChoosingWiselyLogo

I’m a big fan of Pharrell Williams. My housemates endured “Frontin” on repeat in the summer of 2003. That debut Justin album was dope. The Snoop and Jay-Z collaborations super fly. I love the man, but I’ve never heard him quite like this.

“It might seem crazy what I’m about to say
Less is more can often be the best way”

These are words that sing directly to the heart of a geriatrician. In a “parody” of “Happy” by Pharrell, the Choosing Wisely campaign offers us great lines such as

“Antibiotics for a cold will do nothing but make you ill
A routine screen for many things is often overkill”

You really should check out the whole video, full of people of all ages grooving here

The Choosing Wisely campaign originated in America from the American Board of Internal Medicine Foundation. They estimated that up to 30% of care delivered in America is duplicative or unnecessary and may not result in improved health. In response they worked with specialty societies to come up with “Things Providers and Patients should question” And now, as reported in the BMJ, they want to spread their campaign worldwide.

I’ve come across the Choosing Wisely List from the American Geriatrics Society before, and I love it. At work, I often find myself trying to explain treatment decisions by saying things like “Well, prospective cohort studies have consistently failed to demonstrate a benefit in treating asymptomatic bacteriuria in older people. In fact treatment may cause harm by promoting resistance, causing side-effects, and distracting clinicans from the true diagnosis and management plan.” I then try to dig out some paper or guideline to back up my point. Here, the Choosing Wisely campaign has distilled some top tips for geriatric medicine into easy to use recommendations that have more gravitas than an ST5 doctor in a DGH admissions unit. Here are a few of my favourites to trot out:

  • “Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.”
  • “Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.”
  • “Don’t prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effects.”
  • “Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults”

The statements are backed up by references providing details of the underlying evidence base and it is nice to say that this is the opinion of a respected medical society rather than just an individual clinician’s interpretation of the evidence. According to the BMJ, the Academy of Royal Medical Colleges have pointed out that NICE already has “Do not do” recommendations. This may be true, but I think, in the volume of information that NICE produces, some clear recommendations relevant to geriatric medicine get lost.

I, for one, would love to see the BGS team up with Choosing Wisely to disseminate these messages to a British audience.

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