From the July 2017 ACP Hospitalist
With a few tips and tricks, hospitalists can successfully talk to inpatients about high-value care.
What do you do when a confused elderly patient's family asks for a head CT and you think all that's needed is some fluids?
It may be tempting to run out of the room or order the test, but Emily Gottenborg, MD, offered another option in her Hospital Medicine 2017 session on how to talk to inpatients about high-value care.
With a few tips and tricks, “You can have these conversations about high-value care with your patients effectively and feel better about it,” said Dr. Gottenborg, an assistant professor of medicine at the University of Colorado in Denver.
The process starts with sitting down with the patient and family and accepting that it will take some extra time to explain why you're not recommending a low-value test or treatment, she explained.
On the bright side, the conversation might go more smoothly than you expect. “When they ask us questions— ‘Why can't I have that CT?’ ‘When can I get those antibiotics?’ —we make the assumption that they want them and are demanding them from us. But actually they might not be,” said Dr. Gottenborg. “We're not good at predicting this, so let's not make those assumptions as we're sitting down to embark on these conversations.”
Here's another thing not to do: “Don't tell her that a head CT would be a waste of money. She does not want to hear that,” Dr. Gottenborg said. Instead, explain the potential harms to the patient from low-value care, whether it's radiation from a CT scan or Clostridium difficile from antibiotics.
Patients and families may respond with more questions. “‘But, really, doc, what is the downside of testing? Why can't I just get that CT? It would make me feel so much better,’” said Dr. Gottenborg. “Here's where you need to have your anecdotes ready. We've all had the CT or the head imaging that shows the incidentaloma that leads us down a rabbit hole of unnecessary further testing, anxiety, and stress for the patient.”
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ACP Hospitalist provides news and information about hospital medicine, covering the latest trends and issues in the field.