Choosing Wisely

Abstract

Multiple national initiatives seek to curb spending in order to address increasing health care costs in the United States. The Choosing Wisely® initiative is one popular initiative that focuses on reducing health care spending by setting guidelines to limit tests and procedures requested by patients and ordered by physicians. To reduce spending on neuroimaging, the Choosing Wisely® initiative and other organizations have offered guidelines to limit neuroimaging for headaches. Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon’s experience with brain tumor patients. If adopted by governing or funding organizations, these guidelines threaten to negatively impact the care and outcomes of patients with brain tumors, who frequently present with minimal symptoms or isolated headaches syndromes. As we grapple with the difficult conflict between evidence-based cost-cutting guidelines and individualized patient-tailored medicine, a physician must carefully balance the costs and benefits of discretionary services such as neuroimaging for headaches. By participating in the development of validated clinical decision rules on neuroimaging for headaches, neurosurgeons can advocate for their patients and improve their patients’ outcomes.

Impact of early headache neuroimaging on time to malignant brain tumor diagnosis: A retrospective cohort study

“…A missed malignant brain tumor diagnosis is particularly worrisome because while not curable, treatment leads to an increase in survival [16, 27, 28]. Retrospective case series suggest that failing to image individuals with isolated headaches may lead to considerable rates of missed glioma diagnoses as 11% of these individuals putatively present with an isolated headache phenotype [29]. Our data quantify such a concern and demonstrate that few malignant brain tumors are missed.…”

Integrative Understanding of Geriatrics Through Ayurveda: A Review

“…These innate illnesses are brought on by nature and rely on kala (time). Examples of natural diseases are thirst, hunger, old age, mortality, and similar conditions [14,15] .No one can escape these diseases, but they can be changed. A person can avoid ageing and death if they can successfully overcome the constraints of time via the practise of yoga and samadhi.…”

Dying art of a history and physical: pulsatile tinnitus

“…In the present, due to their wide availability, modern physicians oftentimes overuse imaging techniques. Hawasli et al 17 state that headaches consist of 1.5% of all chief complaints in a primary care setting. Irrespective of many neuroimaging guidelines, expenditures for neuroimaging of headaches and migraines in the USA reached nearly US$1.2 billion.…”