Doing More Means Doing Less: Young Innovators Lead the Charge

Jul 23, 2014, 1:28 PM, Posted by Emmy Ganos

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Here at the Robert Wood Johnson Foundation, we often talk about the idea of making the healthy choice the easy choice. To many of us, that means putting the cookies in a high cabinet, and putting the fruit on the counter. But when I think about building a Culture of Health in America, and especially within our health care system, making the healthy choice the easy choice means so much more.

In health care, often the healthy choice actually means doing less—fewer invasive tests and less dependence on medication—and instead watchfully waiting or making healthy lifestyle changes. But it’s not always easy to show a patient that you care when you only have a few minutes to spend together, and ordering a test or prescribing a medication is a simple way to show “I’m doing something to help you.” The trouble is, those tests, procedures and treatments often don't help, and sometimes they can hurt.

Too many people receive unnecessary tests and treatments that don’t help them, and can potentially be harmful to them. Recently, we learned that, every year, about 25 percent of Medicare beneficiaries receive services they don’t need. That means they—and American taxpayers—are paying a lot of money for treatment that provides no benefit. At the same time, there are still far too many people who can’t get the health care they need.

Physicians and researchers tell us that a big part of the overuse problem comes from a “more is better” approach in medicine, and that this approach is conveyed to new doctors as they learn to practice medicine in medical school, and when they start their residencies. In health care, it is easy to err on the side of prescribing a drug or a test or performing a procedure, while the potential harms can be harder to spot.

We believe that clinicians are ready to embrace a new kind of medical culture, one that emphasizes that, often, “less is more.” In addition to other efforts to reduce overuse we have been working with the RightCare Alliance, a project of the Lown Institute, founded by Bernard Lown, MD. Lown encouraged his students to do more for the patient, while doing less to the patient. The RightCare Alliance is working to increase clinician awareness of the causes and consequences of overuse, and to create tools to foster change in the way care is delivered. The project is hosting action-oriented local and national gatherings that focus on reducing overtreatment, fielding a national physician survey to explore underlying drivers of overuse, and developing a toolkit of resources to counter overuse in health care.

Since the “more is better” approach starts in medical training, young innovators in the health professions are just the people to take action to change medicine’s “more is better” philosophy. With support from the Robert Wood Johnson Foundation, the RightCare Alliance has just released a call for proposals for their Young Innovators Grants, which offer funding for students in the health professions, residents, and junior faculty to pilot programs that teach clinicians to recognize and avoid overuse, provide compassionate care, and build more meaningful relationships with patients. Grant award recipients can receive up to $7,000 to cover project expenses, conference travel, and participation in national Right Care Alliance leadership training. We encourage you to check out the call for proposals, and to share it with young innovators in your network!

Those who are just starting out in their health care careers have an important role to play in shaping a Culture of Health, and in making the healthy choice the easy choice in health care. Young innovators are well-positioned to reshape the environments in which they are working, and encourage a culture in which the idea of “more is better” refers to caring and commitment, not to unneeded tests and procedures.