The President & Choosing Wisely

Are the physicians for former President George W Bush - are they Choosing Wisely? The debate for unnecessary testing and treatment was sparked again this week with the announcement of the former President receiving a cardiac stent procedure following a routine physical.

The Choosing Wisely campaign is an effort to decrease unnecessary testing and treatment which is driving up the cost of health care in the United States. In a previous post, I wrote about five reasons why I think this campaign will not succeed.

Some have said that the only way a cardiac stent was placed (possibly) was because of cardiac/heart testing during the routine physical. Should routine heart testing be done in patients without symptoms? Choosing Wisely says no...

  • Do not order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms (American Academy of Family Physicians)
  • Don't perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients (American College of Cardiology)
  • Don't perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (there wasn't even a heart attack here, yet a stent was placed)

Editorials from CBS News, to the Boston Herald, to Bloomberg,com - all these have criticized the physicians of the former President for this course of action. On the other hand, I have had many of my patients this week ask me about heart disease in a healthy 67 year old male who, just a couple of months ago, rode 100k on a bike with injured veterans.

Just like Angelina Jolie's story about cancer risk and cancer markers gave me the opportunity to talk about breast cancer with my patients, this news story has definitely given me the opportunity to talk about heart disease with my patients. The cost debate will continue, but the care debate with patients is always a good one to have...