Should Patients have their own Choosing Wisely list?

I'm possibly Choosing Wisely's most keen fan. Both the American and Canadian campaigns have helped to kick-start the process of shared decision-making between patients and healthcare providers, particularly in the contexts of overdiagnosis and overtreatment.

Some have criticized the campaigns as going after "low-hanging fruit," i.e. targeting the interventions that are not at all controversial, the ones where most doctors have been for years following the Choosing Wisely recommendations. I don't disagree; I'm pleased to say I've been trying to do a lot of the Geriatric and Family Practice suggestions since I started practice. But going after the easy stuff is not a bad idea. We need to start somewhere, and Choosing Wisely's recommendation lists represent the first of many steps towards providing the Right Care. The campaign is about starting a dialogue between patients and providers, making explicit the need to discuss the balance of harms and benefits of particular tests and treatments.

My view is that the broader message, driving campaigns like Choosing Wisely, is about creating a partnership wherein patients are empowered to be responsible for their own health. Patients can ask questions and caregivers can provide expertise and recommendations. Just as a patient has expectations of their physiotherapist or nurse practitioner or specialist, healthcare providers have expectations of their patients too. Everyone involved wants common sense to be applied to the healthcare that's being delivered. There are certain things only doctors can do (ordering the right test, calling a specialist for help) and certain things only patients can do (taking medications as prescribed, exercising regularly). We can help each other out by talking about these things, but we can't actually act for the other person in the equation.

Chatting recently about the campaign to a colleague, and thinking about my own status as a patient, I began to wonder why patient advocacy groups have not yet created their own "Don't" lists. True, patient groups have been involved in the development of Physician Recommendations, however I think it's a bit of a missed opportunity: why not provide patients room for a list of their own?

I think patients are capable of clearly delineating some things that they can do (or not do!) to be healthier and to stimulate discussion with their physicians.

Here are some of my suggestions. Are they way off base? Do you have some of your own? Comment below!

Patient Top 5 Recommendations:

1. Don’t under-value the importance of a healthy lifestyle: avoid smoking, maintain a healthy weight, and exercise regularly. Ask for help if you are having trouble with these things.

2. Don’t wait to seek help for emotional and mental health concerns.

3. Don’t forget to write an Advance Directive and discuss your wishes with your family so they'll know how to best respect them when you are ill or dying.

4. Don’t undertake any test or procedure unless you feel that you understand the potential benefits and harms adequately; remember that you can always refuse.

5. Don’t expect someone else to take ownership for your health but do expect partnership from health providers in helping you achieve your goals.