Greetings, fellow ASE’ers. I’m in DC today and have just completed an amazing press conference to launch the ASE’s participation in the Choosing Wisely campaign. The what, you ask? Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation, intended to promote the appropriate use of medical procedures (read all about it at http://www.choosingwisely.org). To participate in this campaign, interested societies were asked to name five tests or treatments that are used too frequently and inappropriately. For example, the American Academy of Otolaryngology suggest that oral antibiotics not be given for uncomplicated outer ear infections. When we heard about this opportunity at the American Society of Echocardiography, we were very enthusiastic. After all, it has long been our policy to identify and discourage the inappropriate use of echocardiography through our guidelines and participation in the Appropriate Use Criteria (AUC) process. We thought long and hard about our five choices, guided largely by the 2011 Echo AUC publication (J Am Soc Echocardiogr 2011;24:229-67). We discussed it extensively within the Executive Committee, sought advice from our Advocacy Committee, and placed a number of possible choices on the ASE website for commentary from any member who wished to. In the end, we settled on the following five situations in which echocardiography should not routinely be done:
1) Don’t order follow up or serial echocardiograms for surveillance after a finding of trace valvular regurgitation on an initial echocardiogram.
2) Don’t repeat echocardiograms in stable, asymptomatic patients with a murmur/click, where a previous exam revealed no significant pathology.
3) Avoid echocardiograms for preoperative/perioperative assessment of patients with no history or symptoms of heart disease.
4) Avoid using stress echocardiograms on asymptomatic patients who meet “low risk” scoring criteria for coronary disease.
5) Avoid transesophageal echocardiography (TEE) to detect cardiac sources of embolization if a source has been identified and patient management will not change.
I hope you’ll agree with me that these are inappropriate indications, where the likelihood of finding important cardiac pathology is too low to justify the cost and may even be harmful in situations where false positive findings lead the patient to have spurious treatment or unneeded invasive examinations.
I flew in last night and met Robin Wiegerink (our CEO) and Irene Butler (VP for Advocacy) for dinner at Zaytinya, one of Jose Andes’ DC restaurants, featuring the cuisine of the Eastern Mediterranean. We marched through a few small plates of babaghanoush, marinated mushrooms, Santorini-style grilled octopus (yum!), braised lamb shoulder, and others while strategizing for this morning’s events.
After breakfast this morning, we made our way over to the Henry J. Kaiser Family Foundation and their Barbara Jordon conference center where the press conference would take place. There were representatives from 18 medical societies, ranging the gamut from pediatrics to hospice, and pathology to thoracic surgery. For close to an hour, we took questions from Dr. Christine Cassel, President of ABIM, and the public and press in the audience. This was followed by an hour-long panel of health policy and economics experts. It was a great opportunity to network and find new outlets for our message, including Consumer Reports, AARP, and Wikipedia (22 million people viewed the Choosing Wisely information on Wikipedia since its launch last year). ASE has an agreement with Consumer Reports to feature an article on Echo in the coming months, so we are already working with them to provide information that can best influence patient/physician conversations in the future. Afterwards, we rewarded ourselves with a nice lunch at Ceiba, a great Latin American restaurant just around the corner. Then, off to the airport and home again for a busy day reading echoes tomorrow!
I hope you will all go to the Choosing Wisely website and explore the lists produced by all of the societies. I found them fascinating. Also, watch asecho.org as we explore our list in greater detail over the next couple of months. We really want to get the word out on this, demonstrating that education and self-policing is the best way to limit inappropriate echoes, not pre-approval and drastic reimbursement cuts.
Robin, Irene, and I enjoying the cuisine of Greece and Lebanon at Zaytinya.
Robin and I are getting ready for the Choosing Wisely event. The man in the electric blue suit (and matching blue vinyl tennis shoes…) is a Wikipedia guru.
This is Dr. Christine Cassel on the far right, introducing the 18 organizations joining the Choosing Wisely movement. I am on the far left.
There I am in the second row.
Standing with Irene after the event.
And with Robin.
Lunch afterwards at Ceiba.
OK, enough already…here’s some food! Some tasty Baja Mexico style crispy fish tacos.
Grilled shrimp and scallop anticucho.
Grilled octopus salad.