Scott Halpern, NEJM, Video Roundtable, Low-Value Care

Scott Halpern, NEJM, Video Roundtable, Low-Value Care

How to Get Physicians to Adopt More Effective, Less Harmful Treatments and Procedures

LDI Senior Fellow Scott Halpern is one of three expert panelists appearing in a 30-minute New England Journal of Medicine video roundtable on low-value care moderated by Atul Gawande. The issue has become a major one in the wake of the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign that has so far issued recommendations against more than 300 services deemed to be of low-value or even harmful to patients.

To start the roundtable discussion, Gawande, MD, MPH,
Scott Halpern
Scott Halpern: "No-value interventions are probably very few and far between."

asked, "When (a medical service) is widely recognized as providing little or no benefit... what should be done to reduce its use?"

'Very few'
Halpern, MD, PhD, MBE, answered that, "no-value interventions, first of all, are probably very few and far between. There are very few things we do in medicine that truly could not help any patient to which we might consider applying it."

"The right rates at which we utilize these quote-unquote low-value services is not zero," Halpern continued. "We don't want to practice so frugally that we're missing opportunities to provide benefits to patients by not intervening."

'There may be Exceptions'
"So I think at some level, physicians should be comfortable that they can make clearly well-thought-out choices that, although there are recommendations not to do things for the overwhelming majority of patients who fit a particular description, that there may be exceptions where the service is in fact a reasonable choice," Halpern said.

Halpern is Assistant Professor of both Medicine and Epidemiology at the University of Pennsylvania's Perelman School of Medicine; Deputy Director of the LDI Center for Health Incentives and Behavioral Economics (CHIBE); and Director of Penn's FIELDS (Fostering Improvement in End-of-Life Decision Science) program.