Dr Jessica Otte
I'm a Vancouver-based family physician who works as a rural GP in Nunavut and the Northwest Territories, and as a Hospitalist in the Greater Vancouver area. I did my medical undergraduate training at UBC Vancouver, and completed my residency in the (not too big, not too small) 'just right' Nanaimo program on Vancouver Island.
I currently serve on the Canadian Medical Association (CMA)'s Health Care Transformation Working Group (HCT WG) and on the Doctors of BC (formerly BCMA) Council on Health Economics and Policy (CHEP). I believe that change has to happen at both the policy level and the clinical level, and I am keen to encourage both.
Early in my career, I have developed interests in geriatrics, palliative care, rural medicine, and global health; these are all fields that naturally lend themselves to requiring careful choices aligned with patient goals and judicious use of resources. It's no surprise, then, that I often describe myself as a "Less is More" kind of doctor to my patients.
I also consider myself to be very interested in Evidence-Based Medicine (EBM) - with a grain of salt. I take pride in being as up-to-date as possible and in helping patients decide if changes to their care are needed. It is part of the physician's role as medical expert to help interpret the evidence in the context of the patient; sometimes this means finding a way to convince someone that they might really have a better, longer life if they change a particular habit, take one pill every day, or get that "weird thing their body does" sorted out.
A great joy for me is meeting with a patient and their family, finding our more about them and their goals of care, making suggestions about the way to proceed with testing or treatment, and having them say "yes! that's exactly what I want - you understand." When a patient is on-board for the 'appropriate care' approach, I can help them achieve the best health possible by stopping an unnecessary or harmful pill, or starting the right one. We can avoid a test that won't change our management plan, try a less-invasive strategy, or get a potentially serious thing sorted out as quickly as possible with the right test or referral.
I get frustrated, along with my patients, that they cannot always get the things they need. It's not uncommon that a drug that they need is too expensive, a test or surgery they need has too long a wait or is simply unavailable where they live. A fear I have for patients is that they may fall through the cracks of the system if they don't know how to advocate for themselves.
People say that sometimes the hardest thing in medicine is to do nothing. But even when healthcare providers recommend not starting a treatment or decline to order a test or write a referral, we aren't doing nothing. We are thinking carefully about what a patient has told us they want, what the evidence has shown to be effective, and what harm we might do by going too far down the wrong path. Discussing appropriateness in care with patients, we can help individuals make decisions for their best possible care while avoiding harm from unneeded interventions; in the process, the system does not become overburdened with excessive tests and treatments. In part, by doing less of the unnecessary stuff, we can do more of the right stuff.
My experience as a physician and as a patient (I have Transverse Myelitis - you can read about it on my blog) has helped me to see that this style of care - combining shared decision making (SDM) and Evidence-Based Medicine (EBM) - is the future. Hopefully, expounding Less is More will help to dispel some concerns and encourage patients and healthcare providers to consider this approach and to engage in discussions with each other.
Briefly, thank you to all of the generous people who helped refine this site and turn it into the crisp, functioning, happenin' resource that I hope you'll agree it is.
Please use the form below, or email [email protected] to contact me.
The views expressed as part of Less is More medicine are mainly my own, and certainly do not reflect the policy of any health authority or association of which I am a part. My ideas are constantly evolving, so I invite your feedback and criticism.
* The writing on this site and most images are original content, and it would be very unkind to borrow them without permission.