Reflections on Choosing Wisely During a Trip to the Dentist
Meeting over coffee recently, Drs. Christine Goertz and Michele Maiers discovered that each had recently been to the dentist. After comparing notes, they agreed that their dentists were both professional, friendly, conducted a thorough patient history, and performed an appropriate examination. Then both dentists wanted to take intraoral X-rays as part of the examination process. Armed with the evidence and knowledge about current American Dental Association (ADA) guidelines, the chiropractors declined the X-rays, based primarily upon concerns about unnecessary exposure to radiation and cost. From that point on, their experiences became very different.
ACA’s Choosing Wisely recommendations are consistent with X-ray guidance in today’s classroom and trusted texts.
In the past year, many chiropractors have discussed indications for radiographic examination with renewed interest. In particular, they have questioned the X-ray recommendations of the Choosing Wisely initiative, a project of the American Board of Internal Medicine that seeks to promote more effective use of healthcare resources. The recommendations are hardly revolutionary, and well in line with current radiology education. In my own final radiology classes, professors emphasized that what we learned was only the foundation of what we would need in practice, and a mere fraction of what our peers would learn should they choose to become chiropractic radiologists. The recommendations in Choosing Wisely are shorthand for what we already know.
It has been just over a year since many in the chiropractic profession first learned that the American Chiropractic Association (ACA) joined more than 80 medical specialty society partners to participate in an initiative that is sponsored by the American Board of Internal Medicine Foundation. This initiative’s mission is to “promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” It is called the Choosing Wisely campaign1 and it has generated more spirited discussion among doctors of chiropractic than I can recall since release of the Mercy Conference Proceedings in 1993.