A Delicate Balance: How to Avoid Overmedicalization in Rheumatology

Dr. Buchbinder: I think we all need to have clinical epidemiology skills so we can decipher the evidence for ourselves. When I trained in Canada, an introduction to clinical epidemiology course was offered to all fellows starting training in their various specialties; I think that such courses should be mandatory for all trainees because it is a fundamental, core subject area. We should all think critically about what items in our own practices may constitute low-value care. For example, think of the clinician-led Choosing Wisely campaign that encourages us to identify five things in our scope of practice that we should stop doing.¹⁶ When in the clinic with our patients, we should be asking ourselves the same questions that patients should be asking of us when we recommend a test, treatment or procedure. These include:

• What are the benefits?
• What are the harms?
• What would happen if I did nothing or waited?
• What are the alternatives?
• What does the evidence say?
• What are my outcomes?

Only by asking these questions each and every day can we improve the care that we provide to patients.

Jason Liebowitz, MD, is an assistant professor of medicine in the Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons, New York.

References

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