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Medicine Grand Rounds - How Less Health Care Can Sometimes Be Better For You: Examples From Internal Medicine

Dr. Redberg challenges the current healthcare paradigm of “if some is good more is better”, with a call for the reasonable assessment of the need for more testing, a critical view of high-risk medical devices and the benefits of a healthy lifestyle. She cites lung cancer screening and ED visits for low-risk chest pain as examples of how testing can lead to more admissions, higher cost and harm without evidence of improving outcomes. Dr. Redberg also uses the example of an FDA approval process which can lead to the approval of high-risk devices that are not analyzed with clinical trials data for safety or effectiveness. Her suggestions for how to move healthcare systems to higher value care include the need for more rigorous testing guidelines, meaningful clinical outcomes, blinded trials and valid controls. She suggests that reassurances from physicians to patients, and a critical view of testing and invasive procedures could be highly beneficial for patients and the healthcare system.

Activity Details

Start Date: October 19, 2018
End Date: October 19, 2020

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
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  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

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  • Rita F. Redberg, MD, MSc, FACC, FAHA
    Director, National Center of Excellence in Women’s Health
    Professor of Medicine - University of California, San Francisco
    Investigator, Cardiovascular Research Institute
    Chief Editor, JAMA Internal Medicine

    Rita F. Redberg, MD, MSc, is a cardiologist and Professor of Medicine at the University of California, San Francisco. Dr. Redberg is the Chief Editor of JAMA Internal Medicine and has spearheaded the journal’s new focus on health care reform and “less is more”, which highlights areas of health care with no known benefit and definite risks. Her research interests are in the areas of health policy and technology assessment, how to promote high value care with a focus on high-risk medical devices, and the need for inclusion of women in clinical trials of high-risk devices. 

    Dr. Redberg recently completed a 6-year term on the Medicare Payment Advisory Commission, which advises Congress on Medicare payment issues. She is a member of the California Technology Assessment Forum, the Medical Policy Technology and Advisory Committee, Blue Cross Blue Shield Medical Advisory Panel and served on the Food and Drug Administration Cardiovascular Devices Expert Panel. She was a member of the American College of Cardiology’s (ACC) Clinical Quality Committee and served on the Quality in Technology Work Group.

    She graduated from Cornell University and the University of Pennsylvania Medical School and has a Master’s of Science in Health Policy and Administration from the London School of Economics.
Learning Outcome

At the conclusion of this learning activity, participants will be able to recognize the harms and benefits of lung cancer screening and review the yield of diagnostic workup for low risk chest pain and outcomes, which inform the concepts and definition of high value care.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for How Less Health Care Can Sometimes Be Better For You: Examples From Internal Medicine (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Takeda. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
43 Registered Users