As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.
Perhaps the questions we should be asking ourselves, our trainees and our families are:
- Instead of “What’s the matter?” ask “What matters?”
- Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”
Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.
A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.
One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.
When asking for the Pediatric Value Meal, this is one where I will not Super size it!
Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.