Overdiagnosis across medical disciplines: a scoping review | BMJ Open

Curious about which areas of medicine have more problems with overdiagnosis than others? Wondering in which fields the problem has been studied extensively? A group from the Netherlands has looked into this extensively in their paper: Overdiagnosis across medical disciplines: a scoping review for BMJ Open.

One of the biggest challenges in exploring this area is that the problem of 'too much medicine' goes by many different terms, these vary from place to place, and even where the same term is used there is disagreement about definitions. 

Jenniskens, a PhD student at Utrecht University, et al looked at almost 5000 studies and included 1581 for review. Unsurprisingly, the majority of papers pertained to the field of oncology, perhaps because wide-spread screening programs and attempts for early diagnosis are much more common for cancer than for chronic disease and other conditions. Though they did not publish the information, they also took a moment to determine from where in the world the papers were being written.

For years, I have been fascinated with the geographically diverse response to the problem of overdiagnosis and the idea that overdiagnosis can happen in resource-rich and -poor countries alike. I worked with Alan Cassels to facilitate a group discussion at the Preventing Overdiagnosis conference in Barcelona in 2016. We identified movements that attempt to combat overuse of tests, treatments, and procedures around the world (presentation slides are available here) and discussed what factors in each region might be playing a role.

Seeing that presentation and recognizing my interest, Mr Jenniskens has since kindly provided me with a breakdown of the country of origin of the authors for the papers analyzed in his group's review. While most of the papers were tied to the United States, first authors from 65 different countries were among the 1581 papers.

Grey - no authors; Light Green - few authors; Orange - many authors.

Grey - no authors; Light Green - few authors; Orange - many authors.

Please click through to interactive map to view the % proportion of authors of the 1581 assessed papers, originating from each country. From Albania to Zimbabwe, it is clear that overdiagnosis is a global concern, and is being researched everywhere.

Read more about the papers considered in the scoping review.

Source: http://bmjopen.bmj.com/content/7/12/e01844...

Resource Stewardship Toolkit - for education of resident physicians

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Over the past year, I had the opportunity to contribute to the formation of several toolkits on the topic of "Resource Stewardship." These toolkits were created by the Royal College of Physicians and Surgeons of Canada (RCPSC) in partnership with Choosing Wisely Canada and the College of Family Physicians of Canada (CFPC).

The aim was to create modules that educators could use in order to encourage residents to be mindful of overdiagnosis, overtesting, and overtreating as they prepare for practice. By empowering them to have conversations with patients about unnecessary medical interventions and to undertake Quality Improvement projects in this area, preceptors can ensure that physician trainees satisfy the societal duty (as well as a residency education CanMEDS requirement) to be good stewards.

There are THREE toolkits, each containing a powerpoint and preceptor guide:

  1. Foundations - basic information, vocabulary to facilitate residents becoming mindful of considering the (broad) harms and benefits of any test, treatment, or procedure.
  2. Projects - information and guidance on how to undertake a scholarly (eg. research or QI) project in this area
  3. Communication - scenarios, role play, and other resources to help residents communicate with patients and families who may request an unnecessary test, treatment, or procedure

You can find more education resources on the teaching page.

Source: http://www.royalcollege.ca/rcsite/canmeds/...

VIDEO: A troubling pharmaceutical cocktail | Dee Mangin #WalrusTalks

Polypharmacy-smashing superstar Dee Mangin delivered a compelling talk for The Walrus about the problem of too much medicine.

In just over 8 minutes, she beautifully articulates the issue and a vision of how we can address it.

Source: https://www.youtube.com/watch?v=QQkV7yHuQ-...

PODCAST: Preventing Overdiagnosis 2017 - from theory to practice by BMJ talk medicine

My first Podcast!

Dr Navjoyt Ladher of BMJ talk medicine kindly invited a few colleagues and me to participate in an informal discussion at the Preventing Overdiagnosis 2017 conference in Quebec, Canada.

As working clinicians, we explored moments in our careers that got us interested in tackling overdiagnosis, scratched our heads thinking a little bit about why we (and not all of our colleagues) are taking this on, and reflected on take away messages from the conference.

Have a listen, and go to the original site if you wish to join the discussion.

Source: https://soundcloud.com/bmjpodcasts/prevent...

VIDEO: The Truth about Mammograms - Adam Ruins Everything

Here's a great, brief explainer about the problems with mammography (and most cancer screening)  - 2:43

A slightly longer/better version is here on TruTV's website: The Truth About Mammograms - Full Episode (4:30)

Source: http://www.trutv.com/shows/adam-ruins-ever...

What Matters to You? Day - June 6, 2017

"What Matters to You?" Day is June 6, 2017! Ask What Matters. Listen to What Matters. Do What Matters.

 

Medicine is undergoing a huge transformation, shifting away from the historic model of paternalistic, top-down, doctor-driven health care. We started towards patient-driven, consumer medicine, and thankfully are starting to settle at a beautiful middle-ground, which is patient-centred care, using interdisciplinary clinician expertise, and a process of shared decision making around a patient's needs and priorities.

That is a lot of words, when really what it boils down to is this: shifting the emphasis towards caring for people rather than 'doing medicine.'

Or in even simpler terms, we should be asking "What matters to you?" and shaping the care we give to help people find the best fit for their goals. 

This is a new initiative in British Columbia, organized by the BC Patient Safety Quality Council (BCPSQC), to promote meaningful conversations around health care between patients and providers. "What Matters to You?" Day is based on a now global campaign that started in Norway in 2014.

We already incorporate this into our work in the Palliative Care and 'ED2HOME' services at my hospital, but I am keen to help spread the word for this very important idea so that all patients have a chance to answer the question.

From the BCPSQC:

Why does it matter?
Because we believe great care begins with a question. Providing patient-centred care is important because it results in better outcomes for patients and greater satisfaction with care. “What Matters to You?” Day supports this by putting the patient voice at the centre of care, by focusing on what matters to them.

When a health care provider starts a conversation by asking what really matters to the person they are caring for, it helps them to build trust, develop empathy, and understand their patients. Ultimately, it improves the quality of care they provide.

There are lots of ways you can support "What Matters to You?" Day

  • Join us & declare your intention to have a conversation about what matters, whether you're a care provider, patient, family member, or health care provider
  • Download our Getting Started Kit & learn more about the campaign
  • Order free resources to promote "What Matters to You?" Day. We've got posters, pocket cards, stickers, and more resources designed for patients and providers. We'll mail them anywhere in BC! 
  • Spread the word online using our simple, prepared messages and digital resources!
  • Get ready for conversations about what matters with our skill-building tools
  • Watch and share the campaign video, above

Celebrate The Virtual Launch!
We'll be sharing messages about "What Matters to You?" Day across digital channels, so join the conversation on Twitter, Instagram, or Facebook by using the hashtag #WMTY17! You can even add a #WMTY17 Twibbon to your profile photo to spread the word with every message you share!

Learn more: What Matters to You Day

Source: https://bcpsqc.ca/what-matters-to-you-day/

COURSE: Practising Wisely - Reducing Unnecessary Testing and Treatment

When I speak to peers and clinicians, one of the most frequent bits of feedback I receive is "Great! I'm on board with delivering more appropriate care, Choosing Wisely, making sure my patients make shared decisions and avoid unnecessary tests and treatments. But... I don't really know how to 'do' it. Where do I start? How to I talk to patients? Where do I go to practice?"

So, it is with extreme pleasure that I announce the expansion of the Practicing Wisely: Reducing Unnecessary Testing and Treatment Course. Originally "Don't just do something, Stand there!," this highly-regarded hands-on learning experience was started by the Ontario College of Family Physicians and is spearheaded by Dr Jennifer Young.

It is now a suite of continuing professional development opportunities for primary care providers, available in a modular format across the country. In the course: 

Participants will identify opportunities to "practise wisely", with a focus on reducing over-prescribing, over-imaging, over-screening and over-monitoring using the latest evidence and tools from diverse sources. This workshop aligns closely with the Choosing Wisely Canada (CWC) campaign to implement good healthcare stewardship and avoid over-medicalization.

The program centres on case studies and incorporates individual reflection and group work. It helps participants to build communication skills to guide their patients through the shift from seeking sickness to enhancing health.


After active engagement in this program, participants will be better able to:

  • Identify opportunities to reduce “too much medicine”
  • Access and assess reliable, renewing online resources
  • Integrate relevant evidence into individual patient care
  • Communicate and build consensus with patients to reduce over-medicalization

    Upcoming Workshops are taking place as follows:

    May 24/17 - Montreal
    May 29/17 - Ottawa
    June 3/17 - Newfoundland
    Nov 22/17 - Toronto

    Find out more about the Practising Wisely program by viewing the main website or reading through this Q&A with Course Director, Dr. Jennifer Young.

    Source: http://ocfp.on.ca/cpd/practising-wisely

    VIDEO: #ChoosingWisely in Cypress Health Region

    Since 2015, The Saskatchewan Health Quality Council has been moving forward the very important agenda of Appropriateness of Care.

     

    In partnership with the Saskatchewan Medical Association, they have now launched Choosing Wisely Saskatchewan and are working engaging patients, clinicians, and learners to implement a province-wide strategy to tackle overuse. To start, they are focussing on pre-operative testing and imaging of lower back pain, and some of the health regions are taking on their own projects.

    The Cypress Health Region has demonstrated their commitment to Choose Wisely:

    Here's hoping many people will see their example and make the same pledge to choose wisely - because more is not always better in healthcare.

    Source: https://www.youtube.com/watch?v=gkqKRYpKbQ...

    Taking Action on Overuse: A Framework for Change (for Health Orgs & Institutes)

    It has been a while since I discovered any new organizations doing work on the topic of overdiagnosis and the related issues of overtesting and overtreating. Many different projects and initiatives explore the subject; some, like Choosing Wisely, make lists of 'do not do' recommendations. Others, like Minimally Disruptive Medicine provide thoughtful reflection and model practices to show us how to burden our patients less and engage them more. The Lown Institute and their Right Care Alliance work at many levels, be it in political advocacy, cultural change, or clinical education. 

    The Right Care Alliance is sponsored by the Robert Wood Johnson Foundation, something it has in common with Taking Action on Overuse.  While the former is more directed at patients, clinicians, and policy-makers, Taking Action on Overuse is a group that seems devoted to supporting health organizations and institutions. Organizations interested in creating changes to provide fewer unnecessary or harmful tests, treatments, and procedures, can employ the tools Taking Action has created. 

    In their words, "Taking Action on Overuse is an evolving framework for health care organizations to engage their care teams in reducing low-value, unnecessary care and make those efforts last. It identifies evidence-based strategies for obtaining buy-in, motivating behavior changes, and providing the necessary support and infrastructure for health care providers to engage and lead their peers in making the changes that improve the value of health care."

    Their Assessment can help you figure out whether your institution is ready with best practices, and gently guide you there. Likewise, their Framework can help you create the right conditions for change in a climate where many still believe "more is always better."

    Check out their website here to learn more.

    Source: https://takingactiononoveruse.org/

    A national discussion on unnecessary care #ChoosingWisely #Canada

    I am sharing this in case it has not made the rounds. The Canadian Institute for Health Information (CIHI)/Choosing Wisely Canada (CWC) report, Unnecessary Care in Canada, should be available in April. In the meantime you can read briefly about CIHI's role with CWChere.

    (Original post)


    A National Discussion: Unnecessary Care in Canada

    The Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada (CWC) invite you to join us for a discussion on the extent of unnecessary care in Canada.

    This webinar will introduce a new CIHI/CWC report, Unnecessary Care in Canada, and facilitate a conversation about the magnitude of and variation in unnecessary care across several areas covered by CWC’s recommendations.

    The event will include

    • A moderated panel discussion with:
      • David O’Toole, President and CEO, CIHI;
      • Dr. Wendy Levinson, Chair and Co-Founder, CWC; and
      • Dr. Laurent Marcoux, President-Elect, Canadian Medical Association
    • Speakers from the Canadian Partnership Against Cancer, North York General Hospital and other organizations, who will share their success stories about addressing unnecessary care
    • Q & A session

    Date: April 6, 2017
    Time: 9 to 10:30 a.m. ET

    Please note that this webinar will be conducted in English only and will use Eastern Time. To accommodate multiple time zones, a recorded copy of the webinar will be made available. When you register, please specify if you would like the recorded version.

    Registration: To participate, you must have access to the internet, as well as speakers/headphones. The webinar will be accessible on iOS and Android devices (both mobile phones and tablets).

    To register for the webinar, please email Alison Clement at aclement@cihi.ca