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Question from one of our followers on twitter, DocRockne asked us “Did ortho come up with choosing wisely campaign goals? If not, what would yours be?”

Very good question and the AAOS did come up with five practices to be questioned. I must say that while the evidence cited to support each of these five items is extensive and definitely brings into question the use of questionable treatments, the cost savings of 3, 4, & 5 are minimal at best.  I am really pleased the AAOS is on board, but this is a meager start, but a start non the less. Now to the good disruptive AO stuff. Practices I would like to see studied and placed under the microscope are:

1) The liberal use of MRI’s, especially the ones owned by the orthopaedic surgeons themselves. The MRI has in too many cases become a substitute for good old fashioned medical history and physical. This form if the investigative process was, is, and will forever be the cornerstone of the best medicine. No diagnostic test, written or digital algorithm, or Clinical Practice Guidelines will ever replace the algorithm in our head.

2) The indiscriminate prescribing of custom orthotics/arch supports is way out of control and poses tremendous unnecessary medical costs.

There are many practices that are ineffective and expensive and over time they need to be identified and Chosen Wisely. However, each treatment or test, even the five cited by the AAOS and the two I mentioned, must also be allowed to be considered on an individual basis. We just need to do our best job of using them judiciously and WISELY and you must continue to question us regarding need.

I intended to publish this answer to a question March 17, 2014, but I forgot to click the “publish” button, really.  You can’t make this stuff up.  Why do I make this point?  Because of a recent article in the Washington Post In the Health, Science & Environment section called Doctors Overlook Lucrative Procedures When Naming Unwise Treatments came one month later.

I’m not sayin’, I’m just sayin’