The entire medical community is talking about an issue causing risk and harm to patients across the country, but few patients are aware of this conversation.
My bet is that patients want to know, however, so here’s the difficult truth: almost one third of medical care in Canada is unnecessary and over testing and treatment is on the rise. Patients need to be empowered to ask about the risks caused by some tests and treatments, and whether they are really necessary. Remember when patients used to get their tonsils out when they had recurring sore throats? That doesn’t happen anymore because we realized it was overkill.
The conversation that is sweeping the medical community, both here and abroad, is called Choosing Wisely. Choosing Wisely began in the United States in 2012 and we started it in Canada in 2014 — just two short years ago. Part of our goal is to empower patients with information that enables them to speak to their doctor about what’s right for them and what’s not the best choice. Many within the medical community believe we are facing an epidemic of over-diagnosis and overtreatment.
Our campaign, Choosing Wisely Canada, is about improving care and doing tests and treatments that help, not harm, patients. It is not about containing cost. While cost of care is important for our overall health system, as doctors, our first and foremost concern is the health of our patients, and we realize that things must change in order to ensure that the treatments we prescribe are truly having the positive impact on patient health that they are intended to have.
Here’s why both patients and doctors need to change.
Patients sometimes ask for tests and treatments that are not necessarily in their best interest. And doctors often prescribe tests and procedures as a way of covering all possible bases.
Here’s an example. The overuse of powerful radiation scans such as CT and X-ray exposes patients to unnecessary radiation and increases cancer risk. People would be surprised to know how many patients ask their doctor for a CT or MRI scan because they have a headache or low back pain, despite that the tests aren’t recommended for these symptoms alone. And doctors often feel pressured to order the tests their patients request.
Another example: Some patients are being overprescribed antibiotics. The overuse and/or misuse of antibiotics in Canada needs to be talked about because it has real and potentially serious consequences. This includes more instances of antibiotic resistant superbugs like C.difficile being seen in hospitals across Canada.
We need to align doctors with best practice by getting them to stop using various interventions that are not supported by evidence. And we need patients to consider that tests and treatments may sometimes not be necessary and may have potential risks and side effects.
Part of this discussion has to include setting everyone’s expectations of doctor-patient interactions. Too often, both sides feel that a prescription or an ordered test should be the end result. But many times, less is more, and no treatment is the best treatment. Our campaign encourages working together to combat a culture of “more is better,” where the onus is on doctors to “do something” at each consultation, which has bred unbalanced decision-making.
This opinion piece is an updated version of an article that first appeared on the Evidence Network. It has been reprinted with their kind permission.