Time to Pivot?? • “Culture” prepared. Leadership opportunity? • From single topics to broad areas of overuse – – – – – –
Screening—especially heart disease (18 topics) Preop testing in low risk folks and low risk surgery (11 topics) Post intervention testing in low risk patients who do well (12 topics) Drugs---especially antibiotics (12 topics) and those advertised Imaging---especially those involving radiation (19 topics) Safety—especially elective delivery, inappropriate induction
• From one on one conversations to a “practice dialogue” • From large professional societies to communities • From victims of “demand driven healthcare” to engaged patients