A version of this commentary appeared in the Winnipeg Free Press, Policy Options and the Huffington Post
If you knew that virtually the entire medical community was talking about an issue causing risk and harm to patients across the country, wouldn’t you want to know what it is and take part in the conversation?
What if I told you that almost one third of medical care in Canada is unnecessary and that over testing and treatment is on the rise? Doctors across the country are taking note and sounding the alarm on potential risks.
My bet is patients want to know if their medical tests and treatments are exposing them to undue harm. They 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 a short two 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 struggle with decisions about prescribing 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. 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.diff being seen in hospitals across Canada.
We need to change doctors’ practices to align 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 level 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.
Neither the patient nor the doctor is at fault. Patients often go to Dr. Google to self-diagnose, get scared and rush to their doctor looking for some invasive test. Doctors often want to ensure they have left no stone unturned so they order more tests or procedures than are necessary.
We need to change the patient/doctor relationship in order to ensure we eliminate unnecessary medicine.
We need to create a health culture, a patient-doctor relationship, where patients aren’t afraid to ask their doctors about the risks versus benefits of a test or procedure and where doctors feel more comfortable explaining to patients why they might not be necessary. That sort of relationship will be a healthy one.
Dr. Wendy Levinson is Chair of Choosing Wisely Canada, www.choosingwisely.ca and an advisor with EvidenceNetwork.ca.