When Dr. Michael Mooney threads a catheter inside the arteries of a heart-attack patient, he often finds an obstruction beyond the big blockage that is his main target. But, as tempting as it would be to remove the obstruction and prevent it from causing the next heart attack, Mooney follows advice from leading medical authorities to leave it and exit his patient's circulatory system as quickly as possible.
"It can be tempting," he said, "but restraint is clearly in the patients' best interests."
Restraint is the theme of a new campaign called Choosing Wisely Minnesota, which is confronting the American obsession to scan, screen and treat every medical issue whether it presents a threat to the patient or not. Leaving benign blockages behind is one of 11 recommendations organizers will make to Minnesota doctors and patients in an effort to reduce unnecessary and costly medical care.
The 11 targets — ranging from inducing labor prematurely to misusing antibiotics for sinus infections — were selected out of 135 tests and procedures that American medical associations have concluded are wasting money and putting patients at risk.
"Over the years … we've focused on trying to achieve certainty about a diagnosis," said Dr. Tom Kottke, a cardiologist and HealthPartners executive who helped select the 11 procedures. "The fact of life is that diagnoses are always at least a little bit uncertain … So we have ordered lots and lots of tests without thinking about the downside, and the downside isn't just the cost. They can actually be harmful."
Choosing Wisely started as a national campaign two years ago and emerged in Minnesota over the past year with the help of grants to three local health care organizations, including the Minnesota Medical Association, the trade group for the state's doctors. But efforts to educate local doctors and patients on the targeted procedures are just beginning.
On Wednesday, the campaign provided its first webinar to doctors explaining why they shouldn't induce labor or perform surgical deliveries before 39 weeks of gestation unless it is necessary for the health of the mother or fetus.
Thursday will launch various education efforts aimed at patients, so they can make informed decisions about tests and procedures with questionable value. Included are imaging for simple headaches or back pain in the first few weeks, and certain pre-operation tests for low-risk surgeries.