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Healthcare for the Right Reason – Choosing Wisely for Every Patient

Doctor and Patient Discussing Paperwork

How in less than the last 100 years have we gone from the most frugal minded citizens to a more wasteful society? My grandmother lived through the Great Depression and it changed her. In fact, it transformed her entire generation. Our depression era loved ones learned how to make the most out of everything and never wasted. Today Americans struggle to balance the conveniences they want; disposable coffee cups, car dependent cities or perfectly green lawns despite water stressed communities against what they know is right. A more thoughtful look at what is needed for the individual and how it effects the whole is gaining attention again. Healthcare is up against these same challenges as we examine our thinking as the Disposable Generation, asking us to think differently and to challenge our waste.

If we physicians engage in defensive decision making, it is sadly not hard to find redundant, excessive and even potentially harmful care. Sometimes, it can be easy to recognize the potential downside: For example, we all know we shouldn’t order a chest x-ray on every child with a cough. Other decisions are subtler.

Healthcare for the Right ReasonIn 2010, Dr. Howard Brody1 published “Medicine’s Ethical Responsibility for Health Care Reform – The Top Five List,” and started a patient-centered movement on the careful use of health care resources. This initiative has now morphed into what is called the Choosing Wisely Campaign, which has partnered worldwide with 75 societies and 50 consumer organizations, most actively Consumer Reports. These enterprises are asking us to challenge our thoughts and to do the right thing by our patients.

The Choosing Wisely Campaign and other societies have borrowed from the well-recognized five rights of safe medication administration to advocate for selecting the “right test for the right patient at the right time”2. Others have expanded this language to include the “right cost”.3 But, I would submit we should never forget a most important patient right – that we act for the “right reason”.

Remembering the basic tenets of the Hippocratic Oath, we can remember to “make a habit of two things – to help, or at least to do no harm’3. These simple goals ask us to approach each patient thoughtfully and individually. If we are acting under the principle of the Five Rights – Right patient, right test, right time, right cost, right reason – we will be “getting it right” for our nation’s health care, our communities and, most importantly, for our patients.

1: Brody, Howard, Medicine’s Ethical Responsibility for Health Care Reform – The Top Five List, N Engl J Med 2010, 362: 283-285.

2: Lee Hilborne, Choosing Wisely: Selecting the Right Test for the Right Patient at the Right Time. Medical Laboratory Observer, May 18, 2014:

3. Hippocrates Epidemics, Book 1, Section XI (tr. By WHS Jones).

Chief Medical Officer, Aspenti Health™ and Clinical faculty, Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont.

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