Choosing Wisely Initiative

One of the biggest obstacles to successful management of the NHS, and also to any analysis of its current well being, remains the significant lack of any valid information as to what the NHS does, how much it costs and where the money is spent. Indeed, it is perhaps surprising that 'the 1990 changes' were conceived and implemented as fast as they were, given the lack of information that was available in 1988. (Ham, 1996) Attempts were made at the start to ensure that hospitals began from a 'level playing field' so that they were in fair competition with one another, but the sometimes 10 fold differences in the early quoted costs for identical services in different hospitals had as much to do with differing costs of maintaining buildings

With access to prescription drugs, people are able to treat a multitude of diseases and illnesses. These drugs help deal with pain, inability to sleep, depression, and much more. Every day we are increasingly living in a world where there is better living through chemicals. However, what most do not seem to see is the rising tide of pain, illness, and ultimately death being caused by the pills people take every day. Most keep drugs in a special place in their minds, where they see them as harmless. Sadly, this is not the case, and in some cases our prescription drugs can be just as harmful as illegal drugs (King 68).

It has been widely accepted that rationing of the National Health Service (NHS) is paramount to maintaining and balancing public resources. In a utopian world it would be possible to provide every patient with every medical treatment that they would require, however this is not possible and therefore rationing has to be applied by local health authorities. Simply, there are not enough resources and medical staff available to keep up with the ever evolving demands of the public, and once more, these medical resources can’t at times tend to the needs of the medical advancements made every day. Some equipment and medicines are extremely costly and the NHS struggles to balance public budgets in the face of such advancements. One survey of a primary care trust in the NHS found that the panel that made that decision about funding new treatments was faced with applications that would have

Do you smoke, drink or have diabetes? All self inflicted have a massive drain on the NHS. They spend £750m a year on drugs to treat lifestyle diseases and from 2006 the percentage has increased, also treating and all of its complications, diabetes costs £14 billion a year to treat. It is hard to draw the line at what is self inflicted and what isn’t. People need to become more aware at what there doing and how it effects others.

Shared decision-making involves an open and honest conversation between the clinician and the patient. It is a collaboration that takes into account treatment options and the patient’s values and preferences. It gives a patient a voice in their own care. Therefore, pure placebo-prescribing is ethical when the patient has a say – which can foster a placebo effect within the patient. Not from the pill “itself, but rather from the relationship between [the] healer and [the] patient, and the latter’s own capacity for self-healing” (Brody, 1982, 117). In other words, the context in which the pure placebo is prescribed can influence its positive results. Contrastingly, when patients are left out of the decision-making process, there is no room for the clinician’s and patient’s relationship to grow. It also raises the possibility of deception – a concept appearing in almost all of the medical literature on placebo-prescribing in clinical practice.

Currently, most people generally accept a doctor’s word as truth and do not question him or her. When it comes to the medical field, patients can often feel overwhelmed by all the confusing medical terms being thrown at them, so they tend to sit back and do as the doctor says. Healthcare professionals sometimes take advantage of this fact and withhold important information from their patients. For instance, a study conducted by Lisa Lezzoni, MD, and her peers states that more than half of physicians lied to their patients about their diagnosis to put a more positive spin on it (Lezzoni, Rao, DesRoches, Vogeli, and Campbell). Healthcare professionals should disclose to the patient any information pertaining to the patient.

The National Health service is stretched primarily because of the rising demand from demographic changes combined with the growth of new and expensive technology. At the same time, the cut in spending on the on the NHS as a percentage of GDP is limiting its capacity to keep up with demand.

Ambiguity and lack of regulatory control is echoed in David Powner’s article published in the Lancet Journal: “Clinicians do not always follow an established policy or provide appropriate documentation. Surveys or chart reviews showed that doctors sometimes failed to document specifics of clinical examinations, omitted criteria demanded

Henderson, a well known transplant specialist. Dr. Henderson believes medicine in the United States has become a repetitive system of doctors who prescribe patients with similar symptoms generic prescriptions, whether it is surgery or just a medicine, instead of focusing on the individual patient’s needs. He believes the inflation of medical care costs are associated with doctors doing the same thing over and over again. I can personally relate to this because, in February of 2015, I was emitted into the hospital due to excruciating stomach pains. The doctors did not know what was wrong with me, but after I was in the emergency room for over 48 hours, they decided to take out my appendix. Before I went into the surgery, the surgeon reassured me and my parents by saying she has done this surgery hundreds of times, proving an appendectomy is a go-to surgery for stomach pain. The uncertainty of the success of the surgery resolving the problem worried me and my family. Luckily, the surgery did eliminate the preexisting pain. If it had not, however, my parents would have been out thousands of dollars that would go directly to the surgeon’s pockets. Socialized medicine would be able to resolve problems like this one by increasing the quality, safety, and outcomes of each procedure. Dr. Henderson uses the example of Scotland to explain how socialized medicine increased the quality, safety, and outcomes of each procedure. Compared to the United States, Scotland is a lot more advanced medically. The United States can get to Scotland’s level of healthcare by adopting a program of socialized medicine similar to

Although, a large portion of the public feels that some forms of birth control are not safe. Without a prescription from the doctor, many may use the drug incorrectly or unsafely. Especially hormonal birth control, such as the birth control pill, “carries some heightened risks, which is why women who have a history of heart attack, stroke, blood clots and uncontrolled high blood pressure should not use it. Likewise, women who smoke and are over 35 are also at a heightened risk of a medical condition” (Almendrala). Women may not be aware of the health risks of the medicine like doctors and pharmacists do, and using this medicine unaware of those risks may cause medical problems. Additionally, giving the access to this medicine does not guarantee

Quality health care is an issue in America for everyone, despite our numerous tests and advances in technology. In his article, “Overkill,” Atul Gawande argues against a common assumption that our healthcare system is the best because of these medical advances. In fact, Gawande claims that our health care provides much unnecessary care that often causes harm and that costs a lot . He follows that claim by redefining “low-value care” as “no-value care” and provides considerable scientific data along with his own experience with his own patients to support his claim. He also states logical reasons by referring to expert authorities who critique our health care by viewing it from an economic perspective: like talking about information asymmetry where a doctor is more informed than the patient, thus the doctor has more power over the patient. All of these emphases strongly defend his controversial claim. But what stands out most is how Gawande uses several stories showing vastly different outcomes, depending on how informed the patient and doctor are including offering non invasive treatments. We need to explore how his unusual storytelling strategy exposes how surgeons and patients should care more about quality than the mere quantity of tests and what alternatives are available to change the unnecessary over testing and over-diagnosis which prevent good health care.

The Center for Disease Control conducted a study on contraceptive use; their findings concluded “four out of five women have used birth control pills” during one point of their lives (Basset). Birth control pills have been around for over six decades, and their popularity has significantly increased during the past decade. Thousands of sexually-active women are turning to birth control pills as a way to prevent unplanned pregnancy, regulate periods, and to control acne. Nonetheless, birth control pills are synthetic hormones that influence the female body in severe ways. In fact, doctors and media are not presenting the menaces of consuming birth control pills in women; instead, they disguise the risks with commercials of synchronized

1. Write the six questions of the Wise Choice Process and answer each one as it relates to your situation

In 2000, an effort was made by the UK government to resolve certain inequalities that had developed within the NHS by releasing the “NHS Plan of 2000.” This plan greatly increased spending on employee pay, infrastructure, and access to services. Despite almost doubling spending in a ten year period,

Patients in the United States have a right to refuse care if treatment is being recommended for non-life-threatening illnesses according to the Washington School of Medicine (2012). The simple task of refilling a prescription, or choosing to not get a flu shot are all acts of not following through with treatment mechanisms. Patients often times refuse medical treatment for far more reasons than just religious beliefs. Subconscious emotion reasons about side effects, pain, healing time, and the procedure itself scares patient’s away (Washington School of Medicine, 2012).