Canadian Association of Pathologists: Why We Support Choosing Wisely Canada

Dr Christopher Naugler, a pathologist from Alberta (bio), speaks about why the Canadian Association of Pathologists (CAP) support the Choosing Wisely Canada Campaign.

The "Top 5" list of things physicians and patients should discuss, contributed by the CAP can be viewed here.

Having never 'screened' someone for Vitamin D deficiency, I didn't realize how over-ordered the test was. It is a test I have ordered in the North in managing cases of rickets (which still occurs in Nunavut) in conjunction with the advice of a pediatrician or pathologist.

Of course, the Choosing Wisely lists are meant to encourage discussion, and are not blanket statements for all occasions. There are obvious cases where it is wise to order a vitamin D test, and I think the wording of their recommendation captures that :

#1 : Don’t perform population based screening for 25-OH-Vitamin D deficiency.
Vitamin D deficiency is common in many populations, particularly in patients at higher latitudes, during winter months and in those with limited sun exposure. Over the counter Vitamin D supplements and increased summer sun exposure are sufficient for most otherwise healthy patients. Laboratory testing is appropriate in higher risk patients when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections)