July 2, 2022

1400H - 1500H
Via Zoom
Empowerment
objective - for
laypeople to have an
Health Issue understanding of the
Course– importance of Low-
Low-value value Medical Care:
Medical Care: (Unnecessary)
Operations / Operations /
Surgeries Surgeries in the
management of
their health.
 Empowerment
objective - for ROJoson PEP Talk
laypeople to have an
Health Issue understanding of the I have a Patient
Course– importance of Low- Empowerment
Low-value value Medical Care: Program in which I
Medical Care: like to empower the
(Unnecessary)
Operations / lay people or
Operations / patients to take
Surgeries Surgeries in the control in the
management of management of
their health. their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 Empowerment My PEP TALK today
objective - for is entitled: Low-
laypeople to have an value Medical Care:
Health Issue understanding of the (Unnecessary)
Course– Operations /
importance of Low-
Low-value Surgeries.
value Medical Care:
Medical Care: (Unnecessary)
Operations / Operations / This is part of the
Surgeries Surgeries in the Health Issue Course.
management of
their health.
Health Issue Contents of PEP TALK on Low-value Medical Care:
Course– Unnecessary Operations / Surgeries
• What is a low-value medical care?
Low-value • What are the different types of low-value medical
Medical Care: care?
Operations / • What are the causes of low-value medical care?
Surgeries • How common are the low-value medical care?
• What is low-value operation / surgery?
• What are examples of low-value or unnecessary
operations / surgeries?
• What are the causes and types and side effects of
low-value or unnecessary operations?
• What are tips on avoiding or reducing low-value or
unnecessary operations / surgeries?
Health Issue • What is a low-value medical care?
Course–
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What is a low-value medical care?
Course– Low-value medical care is defined as medical care
Low-value or services that provide little or no benefit to
Medical Care: patients, have potential to cause harm, incur
Operations / unnecessary cost to patients, or waste limited
Surgeries healthcare resources.
Health Issue • What is a low-value medical care? NO or LITTLE
Course– BENEFIT is in terms
Low-value medical care is defined as medical care of effectiveness,
Low-value or services that provide little or no benefit to thus, NOT effective
Medical Care: patients, have potential to cause harm, incur in the goal of the
Operations / unnecessary cost to patients, or waste limited medical service
Surgeries healthcare resources. rendered.
Health Issue • What is a low-value medical care? POTENTIAL TO
Course– CAUSE HARM is in
Low-value medical care is defined as medical care terms of RISKS for
Low-value or services that provide little or no benefit to UNWANTED side
Medical Care: patients, have potential to cause harm, incur effects or adverse
Operations / unnecessary cost to patients, or waste limited effects,
Surgeries healthcare resources. complications, and
even death with the
medical service
rendered.
Health Issue • What is a low-value medical care? UNNECESSARY COST
Course– TO PATIENTS is in
Low-value medical care is defined as medical care terms of money
Low-value or services that provide little or no benefit to spent by patients
Medical Care: patients, have potential to cause harm, incur and families for the
Operations / unnecessary cost to patients, or waste limited medical service
Surgeries healthcare resources. rendered which is
considered
UNNECESSARY.
 WASTE LIMITED
Health Issue • What is a low-value medical care?
HEALTHCARE
Course– Low-value medical care is defined as medical care RESOURCES is in terms
Low-value or services that provide little or no benefit to of UNNECESSARY
Medical Care: patients, have potential to cause harm, incur USAGE of a FINITE
Operations / unnecessary cost to patients, or waste limited government
Surgeries healthcare resources. FUNDING / BUDGET
for health of the
citizens like the
PhilHealth and
UNNECESSARY USAGE
of FINITE number of
services like hospital
beds, tests, and
Health Issue • What is a low-value medical care?
Course– Low-value medical care is defined as medical care
Low-value or services that provide little or no benefit to
Medical Care: patients, have potential to cause harm, incur
Operations / unnecessary cost to patients, or waste limited
healthcare resources.
Surgeries
Low-value medical care can be equated to
UNNECESSARY or NOT NEEDED medical care
rendered to patients primarily because of NO or
LITTLE BENEFIT and with POTENTIAL to cause
HARM and secondarily because of unnecessary
cost to patients and waste of limited healthcare
resources.
Health Issue • What is a low-value medical care?
Course– Low-value medical care is defined as medical care
Low-value or services that provide little or no benefit to
Medical Care: patients, have potential to cause harm, incur
Operations / unnecessary cost to patients, or waste limited
Surgeries healthcare resources.

Low-value medical care can be equated to

UNNECESSARY or NOT NEEDED or NOT INDICATED
or NOT in the patient’s best interest when
weighed against other available options, including
watchful waiting and other more conservative
measures.
Health Issue • What is a low-value medical care? vs high-
Course– value medical care?
Low-value
Medical Care: Low-value medical care is defined as medical care
Operations / or services that provide little or no benefit to
Surgeries patients, have potential to cause harm, incur
unnecessary cost to patients, or waste limited
healthcare resources.

High-value medical care is providing the best

medical care possible, efficiently using resources,
and achieving optimal results for each patient.
Health Issue • What are the different types of low-value
Course– medical care?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are the different types of low-value
Course– medical care?
Low-value • Low-value Medical Care: Unnecessary
Medical Care: Medications
Operations / •
Low-value Medical Care: Unnecessary
Surgeries
Diagnostic Tests
• Low-value Medical Care: Unnecessary
Operations or Surgeries
Health Issue • What are the different types of low-value Low-
Course– medical care? value prescription of
Low-value medications –
• Low-value Medical Care: Unnecessary prescription of
Medical Care: Prescription of Medications medications that
Operations / • provides little or no
Low-value Medical Care: Unnecessary
Surgeries benefit to patients,
Diagnostic Tests
may be harmful,
• Low-value Medical Care: Unnecessary incur unnecessary
Operations or Surgeries costs, and waste
healthcare
resources.
Health Issue • What are the different types of low-value Low-
Course– medical care? value prescriptions
Low-value of medications –
• Low-value Medical Care: Unnecessary prescriptions of
Medical Care: Prescription of Medications medications that
Operations / • Low-value Medical Care: Unnecessary provide little or no
Surgeries Examples: benefit to patients,
Diagnostic Tests
• Prescribing antibiotics for viral upper may be harmful,
• Low-value Medical Care: Unnecessary incur unnecessary
respiratory tract infection
Operations
• Prescribing or Surgeries
antibiotics for asymptomatic costs, and waste
bacteriuria healthcare
• Prescribing vitamins and supplements when resources.
they are not indicated.
Health Issue • What are the different types of low-value Low-value diagnostic
Course– medical care? tests – ordering of
Low-value • Low-value Medical Care: Unnecessary diagnostic tests that
Medical Care: Prescription of Medications provide little or no
Operations / • Low-value Medical Care: Unnecessary benefit to patients,
may be harmful,
Surgeries Diagnostic Tests
• Low-value Medical Care: Unnecessary incur unnecessary
Operations or Surgeries costs and waste
healthcare
resources. 
Health Issue • What are the different types of low-value Low-value diagnostic
Course– medical care? tests – ordering of
Low-value diagnostic tests that
• Low-value Medical Care: Unnecessary
Medical Care: provide little or no
Diagnostic Tests benefit to patients,
Operations / • Low-value Medical Care: Unnecessary
Examples: may be harmful,
Surgeries • Ordering preoperative tests (for clearance)
Operations or Surgeries incur unnecessary
prior to low-risk surgeries costs and waste
• Ordering MRI for non-specific low back pain
healthcare
resources. 
Health Issue • What are the different types of low-value Low-value operations
Course– medical care? or surgeries –
Low-value performance of
• Low-value Medical Care: Unnecessary
Medical Care: operations or
Prescription of Medications
surgeries that
Operations / • Low-value Medical Care: Unnecessary
provide little or no
Surgeries Diagnostic Tests
benefit to patients,
• Low-value Medical Care: Unnecessary
may be harmful,
Operations or Surgeries
incur unnecessary
costs and waste
healthcare resources.
Health Issue • What are the different types of low-value Low-value operations
Course– medical care? or surgeries –
Low-value performance of
• Low-value Medical Care: Unnecessary operations or
Medical Care: Operations or Surgeries surgeries that
Operations /
Examples: provide little or no
Surgeries • Circumcision benefit to patients,
• Cholecystectomy for asymptomatic gallbladder may be harmful,
stones incur unnecessary
• Cholecystectomy for gallbladder polyps costs and waste
healthcare resources.
Health Issue • What are the causes of low-value medical
Course– care?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are the causes of low-value medical
Course– care?
Low-value 3 factors:
Medical Care: • Primary factor: Physician-driven factors
Operations / • Secondary factor: Patient-or-consumer driven
factors
Surgeries
Health systems that facilitate practice of low-
value medical care is another factor which may be
more intimately related to the physician-driven
factors (example: no quality control,
incentivization). They may also be related to
patient-driven factors (example: no adequate
patient education).
Health Issue • What are the causes of low-value medical
Course– care?
Low-value Factors:
Medical Care: • Primary factor: Physician-driven factors
Operations / • Secondary factor: Patient-or-consumer-driven
factors
Surgeries
Physicians are the primary factor because of their
greater influencing power in promoting / avoiding
low-value / unnecessary medical care. Patients or
They “call the shot” so to speak. consumers generally
They are the consultants and recommenders. follow advice of
They are the prime movers, primary actors. physicians.
Health Issue • What are the causes of low-value medical Patients or
Course– care? consumers are the
Low-value secondary factor
Factors: because of their
Medical Care: • Primary factor: Physician-driven factors mindset and desires
Operations / • Secondary factor: Patient-or-consumer-driven which the physicians
Surgeries factors want to satisfy above
anything else and
which usually lead to
low-value medical
care.
Health Issue • What are the causes of low-value medical
Course– care?
Low-value Physician-driven factors
Medical Care: • Mindset in medical management – ritualistic
Operations / and maximalist physicians
Surgeries • Financial gain – incentivized or non- More business than
incentivized (personal) compassion sense
• Wish to please patients or consumers – their
mindsets and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
Health Issue • What are the causes of low-value medical
Course– care?
Low-value There are 3 types of physicians based on their
Medical Care: approach to medical problem-solving, decision-
Operations / making and recommendations: (MINDSETS)
Surgeries • RITUALIST physicians
• MAXIMALIST physicians
• MINIMALIST physicians
Health Issue • What are the causes of low-value medical RITUALIST physicians
Course– care? are those who make
Low-value medical
There are 3 types of physicians based on their management
Medical Care: approach to medical problem-solving, decision- decisions based on
Operations / making and recommendations: (MINDSET) HABITS and not
Surgeries • RITUALIST physicians mainly on CRITICAL
• MAXIMALIST physicians ANALYSIS. 
• MINIMALIST physicians

LOW-VALUE
MEDICAL CARE
Health Issue • What are the causes of low-value medical MAXIMALIST
Course– care? physicians are those
Low-value who institute medical
There are 3 types of physicians based on their management that
Medical Care: approach to medical problem-solving, decision- includes a lot of things
Operations / making and recommendations: (MINDSETS) that are NOT essential
Surgeries • RITUALIST physicians Nice to have and needed by a
• MAXIMALIST physicians patient in health
• MINIMALIST physicians restoration and
maintenance. 

LOW-VALUE
MEDICAL CARE
Health Issue • What are the causes of low-value medical MINIMALIST
Course– care? physicians are those
Low-value who institute medical
There are 3 types of physicians based on their management that
Medical Care: approach to medical problem-solving, decision- includes only which
Operations / making and recommendations: (MINDSETS) are essential and
Surgeries • RITUALIST physicians needed by a patient in
• MAXIMALIST physicians health restoration and
• MINIMALIST physicians maintenance.

HIGH-VALUE
MEDICAL CARE
Health Issue • What are the causes of low-value medical FINANCIAL GAIN –
Course– care? incentivized by a
Low-value system in the health
Physician-driven factors care institutions –
Medical Care: • Mindset in medical management – ritualistic with rewards such as
Operations / and maximalist physicians stock dividends,
Surgeries • Financial gain – incentivized or non- perks, free trip
incentivized (personal) abroad, etc.
• Wish to please patients or consumers – their
mindset over the rationalization of care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
Health Issue • What are the causes of low-value medical FINANCIAL GAIN –
Course– care? non-incentivized but
Low-value with enrichment on a
Physician-driven factors personal basis – such
Medical Care: • Mindset in medical management – ritualistic as from more
Operations / and maximalist physicians revenues from
Surgeries • Financial gain – incentivized or non- personally own
incentivized (personal) pharmacy or
• Wish to please patients or More business
consumers than
– their diagnostic business;
compassion
mindset over the rationalization of caresense want more revenues
• Fear of malpractice suits with procedures
• NO clear presentation and discussion of rather than
options of management medications; etc.
Health Issue • What are the causes of low-value medical Pleasing patients on
Course– care? their mindsets and
Low-value desires rather than
Physician-driven factors explaining, educating
Medical Care: • Mindset in medical management – ritualistic and convincing them
Operations / and maximalist physicians on rationalization of
Surgeries • Financial gain – incentivized or non- care.
incentivized (personal)
• Wish to please patients or consumers – their
mindset and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
Health Issue • What are the causes of low-value medical Fear of malpractice
Course– care? suits if undue
Low-value development occurs
Physician-driven factors and when they do
Medical Care: • Mindset in medical management – ritualistic not accede to the
Operations / and maximalist physicians unfounded mindsets
Surgeries • Financial gain – incentivized or non- and desires of the
incentivized (personal) patients and
• Wish to please patients or consumers – their relatives.
mindset and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
Health Issue • What are the causes of low-value medical NO presentation and
Course– care? discussion of BRCA
Low-value data and processes in
Physician-driven factors selection of cost-
Medical Care: • Mindset in medical management – ritualistic effective option.
Operations / and maximalist physicians B – benefit
Surgeries • Financial gain – incentivized or non- R – risk
incentivized (personal) C – cost
• Wish to please patients or consumers – their A – availability
mindset and desires over the rationalization of
care Options B - R - C - A
• Fear of malpractice suits 1
• NO clear presentation and discussion of 2
options of management 3
Health Issue • What are the causes of low-value medical NO presentation and
Course– care? discussion of BRCA
Low-value data and processes in
Physician-driven factors selection of cost-
Medical Care: • Mindset inNOTE:
medical management
High-value – ritualistic
medical care effective option.
Operations / and maximalist physicians
looks for most cost-effective B – benefit
Surgeries • Financial gain – incentivized or non- R – risk
option
incentivized and not just most
(personal) C – cost
effective
• Wish to please option.
patients or consumers – their A – availability
mindset and desires over the rationalization of
care Options B - R - C - A
• Fear of malpractice suits 1
• NO clear presentation and discussion of 2
options of management 3
Health Issue • What are the causes of low-value medical NO presentation and
Course– care? discussion of BRCA
Low-value data and processes in
Physician-driven factors
NOTE: High-value medical care looks for most cost-effective
selection of cost-
Medical Care: •option and not
Mindset injust most effective
medical option. – ritualistic
management effective option.
Options Benefit Risk Cost Availability
Operations / and maximalist physicians
 Treatment B – benefit
• Medications
Surgeries Financial gain – incentivized or non-
 Diagnostic R – risk
incentivized (personal)
Tests
C – cost
 Procedures /
• Operations
Wish to please patients or consumers – their A – availability
mindset and
Option 1  
desires  over the  rationalization
 
of
care
Option 2         Options B - R - C - A
• Fear
Option 3 of malpractice
   suits    
1
• NO clear presentation and discussion of 2
options of management 3
Health Issue • What are the causes of low-value medical
Course– care?
Low-value Patient-or-consumer-driven factors
Medical Care: • Mindset and desires of patients
Operations /
Surgeries
Health Issue • What are the causes of low-value medical
Course– care?
Low-value There are 3 types of patients based on their
Medical Care: approach to medical problem-solving and
Operations / decision-making: (MINDSETS and DESIRES)
Surgeries • RITUALIST patients
• MAXIMALIST patients
• MINIMALIST patients
Health Issue • What are the causes of low-value medical RITUALIST patients
Course– care? are those who make
Low-value medical management
There are 3 types of patients based on their decisions based on
Medical Care: approach to medical problem-solving and HABITS, FADS, and
Operations / decision-making: (MINDSET and DESIRES) not mainly on
Surgeries • RITUALIST patients CRITICAL ANALYSIS. 
• MAXIMALIST patients
• MINIMALIST patients

LOW-VALUE
MEDICAL CARE
Health Issue • What are the causes of low-value medical MAXIMALIST patients
Course– care? are those who desire
Low-value medical management
There are 3 types of patients based on their that includes a lot of
Medical Care: approach to medical problem-solving and things that are NOT
Operations / decision-making: (MINDSET and DESIRES) essential and needed
Surgeries • RITUALIST patients “Nice to have” by a patient in health
• MAXIMALIST patients restoration and
• MINIMALIST patients maintenance. 

LOW-VALUE
MEDICAL CARE
Health Issue • What are the causes of low-value medical MINIMALIST patients
Course– care? are those who desire
Low-value medical management
There are 3 types of patients based on their that includes only
Medical Care: approach to medical problem-solving and which are essential
Operations / decision-making: (MINDSET and DESIRES) and needed by a
Surgeries • RITUALIST patients patient in health
• MAXIMALIST patients restoration and
• MINIMALIST patients maintenance.

HIGH-VALUE
MEDICAL CARE
Health Issue • How common are the low-value medical care?
Course–
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • How common are the low-value medical care?
Course–
• Very common abroad and in the Philippines
Low-value • Present since time immemorial
Medical Care: • Since start of medical profession (BCE) up to
Operations / now (CE) when physicians and health care
Surgeries institutions and patients are NOT conscious of
low-value medical care
• Formal movement advocating high-
value and reducing low-value medical
care initiated only when government
health financing system was being
challenged
 Spreading globally across
Health Issue • How common are the low-value medical care? Europe and Asia to over
Course– 20 countries around the
A popular movement – Choose Wisely (USA – world.
Low-value
2012) - Mission is to promote conversations
Medical Care: • Now there is
between clinicians and patients by helping
Operations / patients choose care that is:
formal tracking of
Surgeries low-value medical
 Supported by evidence care in hospitals in
USA, England,
 Not duplicative of other tests or Australia, New
procedures already received Zealand, to name a
 Free from harm few.
• None yet in the
 Truly necessary Philippines.
Health Issue • How common are the low-value medical care? NO presentation and
Course– discussion of BRCA
VERY COMMON because in practically all data and processes in
Low-value
prescriptions of medications; ordering of selection of cost-
Medical Care: effective option.
diagnostic tests; and performance of operations
Operations / or surgeries, there is ALWAYS a potential or risk of B – benefit
Surgeries low-value medical care because of physician-, R – risk
patient- and health systems-driven factors. C – cost
A – availability
Particularly, when physicians do not
Options B - R - C - A
present and discuss BRCA data and 1
processes with patients. 2
3
Health Issue • LOW-VALUE OR UNNECESSARY OPERATIONS / Today, in this
Course– SURGERIES ROJoson PEP Talk,
Low-value we will focus on low-
value or unnecessary
Medical Care: OPERATIONS /
Operations
Diagnostic / SURGERIES.
Surgeries
Tests I have discussed
unnecessary
prescriptions and
unnecessary
diagnostic tests the
previous weeks.
Health Issue • What is low-value or unnecessary operations /
Course– surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What is low-value or unnecessary operations /
Course– surgeries?
Low-value
Medical Care: Low-value operations / surgeries –
Operations / performance of operations / surgeries that
Surgeries provide little or no benefit to patients, may
be harmful, incur unnecessary costs, and
waste healthcare resources.
Health Issue • How common are low-value or unnecessary
Course– operations / surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • How common are low-value or unnecessary Low-value Medical
operations / surgeries? Care:
Course– • Unnecessary
Low-value Medications
Medical Care: Among the three types of low-value medical care, • Unnecessary
Diagnostic Tests
Operations / • Unnecessary
Surgeries low-value prescription of medications is
Operations or
most frequent (No. 1). Surgeries

Low-value ordering of tests is 2nd most

frequent.
Low-value operations is 3rd most frequent.
Health Issue • What are the causes of low-value operations /
Course– surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are the causes of low-value operations /
Course– surgeries?
Low-value 3 factors:
Medical Care: • Primary factor: Physician-driven factors
Operations / • Secondary factor: Patient-or-consumer driven
Surgeries factors
• Tertiary factor: Health systems factors
Health Issue • What are the causes of low-value operations /
Course– surgeries?
Low-value Physician-driven factors
Medical Care: • Mindset in medical management – ritualistic
Operations / and maximalist physicians
Surgeries • Financial gain – incentivized or non- More business than
incentivized (personal) compassion sense
• Wish to please patients or consumers – their
mindsets and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
Health Issue • What are the causes of low-value operations /
Course– surgeries?
Low-value Patient-or-consumer-driven factors
Medical Care: • Mindset and desires of patients
Operations /
Surgeries
Health Issue • What are the causes of low-value operations /
Course– surgeries?
Low-value Health system factors
Medical Care: • Facilitating, allowing, no policing, no quality
Operations / control of practices of physicians
Surgeries • Inadequate public health education, patient-
centered care management program or
patient-empowerment program
Health Issue • What are the types of low-value operations /
Course– surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are the types of low-value operations /
Course– surgeries?
Low-value
Performing operations / surgeries that are:
Medical Care: • Not needed (just watchful waiting or
Operations / medications will do)
Surgeries • Not proven effective
• Inappropriate to use in consideration of other
options
• Unsafe for all patients and to certain patients
• Costlier than other equivalently effective
operations (not cost-effective)
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value All operations / surgeries have side-effects, both
Medical Care: expected and potential.
Operations /
Surgeries First expected side-effects are pain if there is an
incision or cut on the skin and discomfort if the
procedure does not entail incision or cut on the
skin such as endoscopy. These are the initial
unavoidable side-effects.
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value All operations / surgeries have side-effects, both
Medical Care: expected and potential.
Operations /
Surgeries
Second expected side-effects are those resulting
from manipulation of deeper or internal tissues
and organs such as pain, discomfort, numbness
because of cut superficial sensory nerves, etc.
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value All operations / surgeries have side-effects, both
Medical Care: expected and potential.
Operations /
Surgeries
If there is removal of some essential organs, the
third expected side-effects are those resulting
from the removal such as lack of some essential
hormones needing replacement or impaired
functioning of some body parts needing
rehabilitation.
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value All operations / surgeries have side-effects, both
Medical Care: expected and potential.
Operations /
Surgeries
After the expected side-effects, the surgeons will
try to control all the risks for potential side-effects
or complications of the operation like bleeding,
infections, anastomotic leak, dehiscence, even
death, etc.
However, NO surgeon will guarantee against their
occurrence.
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value Thus, all operations / surgeries have side-effects,
Medical Care: both expected and potential.
Operations /
Surgeries If there is no need for an operation / surgery, Don’t go for low-
don’t go for it; don’t go through it. value operations.

However, if there is really a need for an Go for high-value

operation / surgery, go for it; go through it. operations.
Health Issue • What are the side-effects of low-value
Course– operations / surgeries?
Low-value Potential side effects with low-value operations /
Medical Care: surgeries:
Operations / • Unnecessary
Surgeries • physical harm
• psychological harm (poor quality of life)
• cost
• waste of limited healthcare resources
Health Issue • What are examples of low-value or
Course– unnecessary operations / surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are examples of low-value or NO presentation and
Course– unnecessary operations / surgeries? discussion of BRCA
Low-value data and processes in
Here, I will just give a few examples. selection of cost-
Medical Care: effective option.
Operations / Remember what I said earlier: B – benefit
Surgeries In practically all performance of operations, there R – risk
is ALWAYS a potential or risk of low-value medical C – cost
care because of physician-driven, patient-driven A – availability
and health systems-driven factors. Options B - R - C - A
Particularly, when physicians and surgeons do not present
1
and discuss BRCA data and processes with patients. 2
3
Health Issue • What are examples of low-value or Low-value
Course– unnecessary operations / surgeries? operations /
Low-value surgeries –
In the Choose Wisely website, one can see
Medical Care: performance of
hundreds (this is still partial) of examples of low-
Operations / value or unnecessary operations / surgeries which operations /
they are trying to educate the physicians / surgeries that
Surgeries
surgeons and public to avoid. provide little or no
benefit to patients,
Link: may be harmful,
https://www.choosingwisely.org/clinician-lists/ incur unnecessary
costs and waste
healthcare
resources. 
Health Issue • What are examples of low-value or Low-value
Course– unnecessary operations / surgeries? operations /
Low-value surgeries –
Examples:
Medical Care: performance of
Operations / • Avoid routine cholecystectomy for patients operations /
surgeries that
Surgeries with asymptomatic cholelithiasis.
provide little or no
• Don’t routinely surgically excise biopsy proven benefit to patients,
fibroadenomas that are smaller than 2 may be harmful,
centimeters in size. incur unnecessary
costs and waste
healthcare
resources. 
Health Issue • What are examples of low-value or Low-value
Course– unnecessary operations / surgeries? operations /
Low-value surgeries –
Examples:
Medical Care: performance of
Operations / • Don’t routinely operate for a breast abscess operations /
surgeries that
Surgeries without an initial attempt to percutaneously
aspirate or drain it. provide little or no
benefit to patients,
• Don’t routinely perform a double mastectomy may be harmful,
in patients who have a single breast with incur unnecessary
cancer. costs and waste
healthcare
resources. 
Health Issue • What are examples of low-value or Low-value
Course– unnecessary operations / surgeries? operations /
Low-value surgeries –
Examples:
Medical Care: performance of
Operations / • Don’t perform surgery for plantar fasciitis operations /
surgeries that
Surgeries before trying at least six months of non-
operative care. provide little or no
benefit to patients,
• Do not perform routine oophorectomy in may be harmful,
premenopausal women undergoing incur unnecessary
hysterectomy for non-malignant indications costs and waste
who are at low risk for ovarian cancer. healthcare
resources. 
Health Issue • What are examples of low-value or NO presentation and
Course– unnecessary operations / surgeries? discussion of BRCA
Low-value data and processes in
Here, I will just give a few examples. selection of cost-
Medical Care: effective option.
Operations / Mind you -- VERY VERY COMMON as in practically B – benefit
Surgeries all performance of operations, there is ALWAYS a R – risk
potential or risk of low-value medical care C – cost
because of physician-driven, patient-driven and A – availability
health systems-driven factors.
Particularly, when physicians and surgeons do not present Options B - R - C - A
and discuss BRCA data and processes with patients. 1
2
3
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care:
3 factors on the causes:
Operations / • Primary factor: Physician-driven factors
Surgeries • Secondary factor: Patient-or-consumer driven
factors
• Tertiary factor: Health systems factors

What can you do as a layperson or patient?

Health Issue • What are tips on avoiding or reducing low- Doctors and health
Course– value or unnecessary operations / surgeries? institutions are
trying to police
Low-value
themselves now
Medical Care: because of the
3 factors on the causes:
Operations / • Primary factor: Physician-driven factors Choose Wisely
Surgeries • Secondary factor: Patient-or-consumer driven movement (started
factors in 2012).
• Tertiary factor: Health systems factors
• How long will it
take?
• How successful
What can you do as a layperson or patient? will it be?
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care:
3 factors on the causes:
Operations / • Primary factor: Physician-driven factors
Surgeries • Secondary factor: Patient-or-consumer driven You can do
factors your part here!
• Tertiary factor: Health systems factors For your own
sake!
For your
brethens’ sake!
What can you do as a layperson or patient?
Health Issue • What are tips on avoiding or reducing low- BE EMPOWERED AS
Course– value or unnecessary operations / surgeries? A PATIENT!
Low-value
ADVOCATE PATIENT
Medical Care: EMPOWERMENT!
3 factors on the causes:
Operations / • Primary factor: Physician-driven factors
Surgeries • Secondary factor: Patient-or-consumer driven You can do
factors your part here!
• Tertiary factor: Health systems factors For your own
sake!
For your
brethens’ sake!
What can you do as a layperson or patient?
Health Issue Be always in touch with reliable medical
HIGH-VALUE
Course– information on low-value (unnecessary) and high-
MEDICAL CARE
Low-value value (highly recommended) medical care.
Medical Care: Knowledge is power; it gives power. Low-value Medical
Operations / Use the 4Ks of Patient Empowerment: Care:
Surgeries • Unnecessary
Kaalaman, Kakayanan, Karapatan and Medications
Kapangyarihan • Unnecessary
Diagnostic Tests
to gain greater control over decisions in
• Unnecessary
medical management of oneself in Operations or
promoting high-value medical care and Surgeries
avoiding low-value medical care.
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care: Strategies:
Operations / • Be constantly aware of and vigilant against
Surgeries potential for low-value performance of
operations / surgeries by physicians /
surgeons. Always aim and insist for a high-
value operations / surgeries from them.
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care: Strategies:
Operations / • Be proactive
constantlyinaware
controlling
of andand
vigilant
avoiding
against
low-
Surgeries potential
value operations.
for low-value
Makeperformance
the physicians
of aware
that you know
operations / surgeries
the processes
by physicians
on how/to
surgeons.
reduce low-value
Alwaysand
aimhow
and insist
to promote
for a high-
high-
value operations.
operations /Have
surgeries
a shared
fromcollaboration
them.
with the physicians in accomplishing these.
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care: Strategies:
Operations / • Before accepting the recommendation for an
Surgeries operation, ask the physician:
• What is specific pretreatment diagnosis
with quantification of degree of certainty
or probability?
• What is the goal of the operation?
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Strategies:
Medical Care:
• Before accepting the recommendation for an operation, ask the
Operations /
physician:
Surgeries
• What are the options for treatment? (include watchful waiting and
more conservative measures like medications as options)
• Is watchful waiting a good option for treatment? What are the
chances the medical condition / disease will resolve spontaneously
without treatment / without operation? If more than 50%,
watchful waiting is a good option.
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Strategies:
Medical Care:
• Before accepting the recommendation for an operation, ask the
Operations /
physician:
Surgeries
• Is a more conservative measure like medication a good option for
treatment? What are the chances the medical condition / disease
will resolve with medications / without operation? If more than
50%, the more conservative measure is a good option.
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Strategies:
Medical Care:
• Before accepting the recommendation for an operation, ask the
Operations /
physician:
Surgeries
• What are the comparative data and information on the various
options in terms of benefit (effectiveness); risk; cost; and
availability parameters? What is his recommendation on the cost-
effective option?
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value Always use BRCA Process in selecting cost-
Medical Care: effective treatment (include watchful waiting and
Operations / more conservative measures like medications as
Surgeries options)

Options Benefit Risk Cost Availability

 Treatment
Option 1        
Option 2        
Option 3        
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Strategies:
Medical Care:
• Before accepting the recommendation for an operation, ask the
Operations /
physician:
Surgeries
• When the physician asks for your response to his recommendation,
feel free to ask as many questions that you may have on the data
and information presented and also, ask him to temper and
validate your personal biases (mindset and desires) in favor of an
objective decision-making.
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care: Strategies:
Operations / • You are free and have a right to seek a second
Surgeries opinion if you want. However, when you do
this, follow the same processes mentioned
above.
Health Issue • What are tips on avoiding or reducing low- Patients do not
Course– value or unnecessary operations / surgeries? know whether there
Low-value are ulterior motives
behind physicians’
Medical Care: recommendation for
Some more recommendations.
Operations / operation such as
Surgeries incentivization and
personal business
sense.
Health Issue • What are tips on avoiding or reducing low- Patients do not
Course– value or unnecessary operations / surgeries? know whether there
Low-value are ulterior motives
The best diplomatic strategy to prevent this ulterior motive
behind physicians’
Medical Care: is to ask the physicians to present and discuss the recommendation for
comparative data and information on the benefit, risk, cost
Operations / and availability of the different options of treatment. operation such as
Surgeries Analyze them and then make a judgement on physician’s incentivization and
competency and presence of ulterior motives. personal business
Options Benefit Risk Cost Availability sense.
 Treatment
Option 1        
Option 2        
Option 3        
Health Issue • What are tips on avoiding or reducing low- Commendable
Course– value or unnecessary operations / surgeries? physician’s attitude
Low-value that will prevent
low-value operation
Medical Care: “I’m not going to prescribe a low-value operation
just because of
Operations / just because a patient has requested it. I just think
wanting to satisfy
Surgeries that we need to talk more about it so we can get
mindsets and desires
on the same page.”
of patients.
“But when I feel strongly that something… has
harms then I guess I am less likely to take the
patient preference.”
Health Issue • What are tips on avoiding or reducing low- Commendable
Course– value or unnecessary operations / surgeries? physician’s attitude
Low-value that will prevent
low-value operation
Medical Care: “I am sorry your perceptions on a particular
just because of
Operations / option of treatment for this medical condition are
wanting to satisfy
Surgeries myths, incorrect and unfounded. I have to correct
mindsets and desires
you through these explanations.”
of patients.
“I am sorry we have to decide on what type of
treatment option to take based on hard evidences
and not based on fad and popular practices.”
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value My personal practice:
Medical Care: - I use the BRCA to advise and to make
Operations / recommendations as objectively as possible
Surgeries and honestly and compassionately.
- I respect patients’ desires but I enlighten them
if they have misconceptions.
Options Benefit Risk Cost Availability
 Treatment
Option 1        
Option 2        
Option 3        
Health Issue • What are tips on avoiding or reducing low-
Course– value or unnecessary operations / surgeries?
Low-value
Medical Care:
Operations /
Surgeries
Health Issue Contents of PEP TALK on Low-value Medical Care: Summary
Course– Unnecessary Operations / Surgeries Take Away
• What is a low-value medical care?
Low-value • What are the different types of low-value medical
Medical Care: care?
Operations / • What are the causes of low-value medical care?
Surgeries • How common are the low-value medical care?
• What is low-value operation / surgery?
• What are examples of low-value or unnecessary
operations / surgeries?
• What are the causes and types and side effects of
low-value or unnecessary operations?
• What are tips on avoiding or reducing low-value or
unnecessary operations / surgeries?
Health Issue Be always in touch with reliable medical Take Away in
Course– information on low-value (unnecessary) and high- relation to
Low-value value (highly recommended) medical care.
Patient
Medical Care: Knowledge is power; it gives power. Empowerment
Operations / Use the 4Ks of Patient Empowerment:
Surgeries Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of oneself in
promoting high-value medical care and
avoiding low-value medical care.
 Empowerment
objective - for
laypeople to have an
Health Issue understanding of the
Course– importance of Low-
Low-value value Medical Care:
Medical Care: (Unnecessary)
Operations / Operations /
Surgeries Surgeries in the
management of
their health.