COVER FEATURE: Dr Otte/Less is More Medicine in Canadian Family Physican

It is a pleasure to announce that the March edition of the Canadian Family Physician (CFP) almost entirely consists of articles that pertain to the 'right amount' of medicine; among them is a cover story about me (Jessica Otte) and Less is More Medicine.

Check out the cover article for yourself!

The CFP has recently shifted their covers to feature physicians who are practicing social accountability in medicine. It was an honour to be featured and, in so doing, bring attention to the need for real patient-centred care and consideration of the harms of too much medicine.

This month's journal is a seminal edition for the fight to find patients the right health care, thanks to the other related articles showcased:

Rational test ordering in family medicine

It is typical in medical teaching to start an article or talk with a case.

What is not typical about about this Canadian Family Physician (CFP) article, written by Australians Drs S Morgan, M van Driel, J Coleman, and P Magin, is that the case is not meant to teach us how to do something. It is meant to challenge us, to teach us how NOT to do something.

When a 'routine annual health check' involves non-evidenced tests, and abnormal results are found, it leads to further testing; anxiety and other harmful effects of the testing cascade or treatments develop. This is the problem of overtesting and overdiagnosis.

It is best to not order irrational, unjustified tests "just to see" because there are harms of "just seeing." If you order enough tests, there will definitely be abnormal findings, many of which are spurious or clinically insignificant.

Many of those reading know this problem, but we are not always sure of the solutions. Morgan et al suggest and expand upon these mitigating steps:

  • Undertake a thorough clinical assessment
  • Consider the probability and implications of a positive test result
  • Practise patient-centred care
  • Follow clinical guidelines or seek other specialist guidance (*my caveat: if the guidelines are reasonable, free of industry bias, and appropriate for the patient in front of you)
  • Do not order tests to reassure the patient
  • Accept a degree of uncertainty
  • Use serial rather than parallel testing
  • Reflect and critically appraise test ordering

I like the list as it challenges some myths, like "ordering the test will make the patient feel better." Many of the drivers of overtesting explained here overlap with the Contributing Factors piece I'm working on, though I'm inspired that perhaps "taking time" (using a longitudinal relationship to slow down, to do serial testing, etc.) may need to be added to the list.

View the article in the CFP to read more.



Source: http://www.cfp.ca/content/61/6/535?etoc

Achieving optimal prescribing: What can physicians do?

Dr Sam Shortt offers direction and a call to action for physicians to achieve optimal prescribing patterns.

Some drugs are prescribed more frequently than is appropriate. Antibiotics, for example, are often prescribed for children with minor respiratory illnesses that are likely viral in origin. The underuse of clinically indicated medication is another type of suboptimal prescribing. Canadian studies have shown underuse of lipid-lowering agents, blood pressure drugs, medications for congestive heart failure, and prescriptions for post–myocardial infarction care. Finally, practitioners might make incorrect drug choices that might result in harm to patients.

Read more in CFP.