Patients and doctors must face a culture change to avoid unnecessary tests and treatments that could cause harm, Canadian medical groups say.
In launching its Choosing Wisely campaign Wednesday, the Canadian Medical Association said it's meant to help physicians and patients "engage in conversations about unnecessary tests, treatments and procedures," and help them make smart choices for high-quality care.
The campaign is about changing the culture of more is always better and quality care, said Dr. Wendy Levinson, founder of Choosing Wisely Canada.
"The goal of Choosing Wisely Canada … is to ensure patients get right care and not what they don't need," Levinson told reporters.
Levinson, a professor in the faculty of medicine at the University of Toronto, advocates a "think twice attitude."
"Instead of just talking about what are all the potential tests you can order, we now talk about what are the pros of the test, what are the cons of these test when is it appropriate, and when is it maybe not appropriate and even harmful to the patient," said Raman Sridastava, a second-year medical student at the University of Toronto, where the U.S. campaign is shaping their lessons.
Since the U.S. campaign began in February 2012, specialists created lists of what doctors and patients should question, based on evidence of overuse, waste and potential harm.
In Ottawa on Wednesday, specialty groups each released their top five lists of what physicians and patients should reconsider because they aren't seen as being needed in all circumstances. These include:
- Don't do imaging for lower-back pain unless red flags are present.
- Don't use antibiotics for upper respiratory infections that are viral infections such as flu or sinus infections lasting less than seven days that are likely to clear up on their own.
- Don't order screening chest X-rays or ECGs for people with no symptoms at low risk of coronary heart disease.
- Don't screen women with Pap smears if under 21 years of age or over 69.
- Don't do annual screening blood tests unless directly indicated by the patient's risk profile. Otherwise, there could be false positive results that may lead to unnecessary tests.
The list is prescriptive, not "never dos," so doctors and patients will still have flexibility, Marisa Leon-Carlyle, a second year medical student at U of T, said in an interview.
"If someone comes in because they have a cough or a cold or back pain or a headache, you want to feel like you did something for them," said Leon-Carlyle. "You want to make them feel satisfied, but you also have to recognize that maybe prescribing to them an antibiotic or ordering a test for them isn't actually what is best for the patient."
The specialty societies participating in the first wave of Choosing Wisely Canada are:
- Canadian Association of General Surgeons.
- Canadian Association of Radiologists.
- Canadian Cardiovascular Society.
- Canadian Geriatrics Society.
- Canadian Medical Association Forum on General and Family Practice Issues.
- Canadian Orthopaedic Association.
- Canadian Rheumatology Association.
- Canadian Society of Internal Medicine.
The Quebec Medical Association also launched the francophone component of the campaign, Choisir avec soin.
Other medical schools will also participate.
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