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

    Quality Forum: A New Kind of Rounds (Teaching patient-centred care that avoids unnecessary and harmful interventions)

    I have followed the Do No Harm project and their articles in JAMA's Teachable Moments section (under the Less is More theme). Then, at the Lown Institute's Road to Right Care conference, I learned more about "Right Care Rounds," and in Nanaimo we developed our own version.

    More background information and the talk from our first session, on the subject of treatment of Type 2 Diabetes in the elderly, can be found here.

    Following the success of this event, we decided to do more of them. Our next one is tentatively in April and will be on the subject of overtreatment of hypertension. Thinking, "why not spread the message of what we are trying?," we've created a poster that I will present at the BC Quality Forum.

    You can view the full poster 'storyboard' by clicking the image below.
     

    A New Kind of Rounds: Type 2 Diabetes in the Elderly CME

    Thanks to my local Division of Family Practice and the Practice Support Program (PSP), we were able to put together "A New Kind of Rounds" event all about helping patients find the right amount of medicine. 

    Our first event, focussed on Type 2 Diabetes in the Elderly, and specifically the harms of treating this too aggressively. Inspired by the Lown Institute's RightCare Rounds and the DoNoHarm Project, we started with patient cases in which the patient's perspective highlighted the burden of treatment and the potential harms of too much medicine.

    After small-group case learning, I presented a didactic session reviewing the unique factors that change our approach to management in the elderly, the best available evidence on diagnosis and treatment targets, the current guidelines, and some resources that clinicians and patients can refer to in order to make shared decisions about the "right amount" of care.

    The event was well-attended and it was heartwarming to see the level of engagement on this topic from clinicians in our community; we are reviewing the evaluations to consider some changes to the format. Participants also generated an amazing of possible topics for future events, from hypertension to cancer-screening, and anti-psychotic use in the elderly to the annual physical. 

    The slides are available here.

    Your feedback is most welcome. You can comment below or e-mail. 

    My other lectures can be viewed here.

    Source: http://prezi.com/ln78vzbqpu4-/?utm_campaig...

    Transfusion Medicine for Physicians

    Did you know that there is an online, CME-Accredited course regarding the use of blood products?

    In the area of transfusions, Less is often more!

    Emergency and Family physicians, hospitalists, internists, residents and surgeons could all benefit from learning the when, why, and hows of transfusion.

     

    See the PDF Flyer or go to the website to learn more and register!

     

    Overall Learning Objectives:
    After participation in this course, the learner will:

    1. Appropriately interpret clinical signs and symptoms of reduced oxygen carrying capacity and utilize hemoglobin concentration to determine need for RBC transfusion.
    2. Be confident their RBC transfusion ordering practice is up to date and reflects current literature.
    3. Apply the appropriate elements of informed consent for transfusion.
    4. Appreciate the indirect relationship of common coagulation tests to bleeding risk and the role of frozen plasma transfusion.
    5. Recognize and respond appropriately to adverse transfusion events or reactions.
    6. Know where to seek further advice on transfusion management.

     

    Source: http://www.pbco.ca/index.php/education/phy...

    PRESENTATION SLIDES: Choosing Wisely (& Beyond): Starting Conversations Around Unnecessary Tests and Procedures

    The slides from my UBC CPD 50th Annual Post Graduate Review in Family Medicine talk are now available, here on Prezi.

    The handout can be seen here.

    Start with the 11 recommendations for family practice physicians/patients from Choosing Wisely Canada, and then please explore this website to find out more. Read about other projects, attend a conference or event, or try out a shared decision making tool.

    I would value any feedback via Twitter (@LessIsMoreMed) or via email, whether about the talk (if you attended) or about this website or topic in general.


    It was a pleasure to share this brief presentation, to hear the great questions and discussions on the subject, and to see how these challenges were highlighted in the other talks of the day. Inappropriate health care (or "too much & too little medicine") is a prevalent issue. Hopefully starting with campaigns like Choosing Wisely and the effort to curate similar projects/conferences/resources with "Less is More in Medicine" provides a good start to tackling this immense issue.

    20 minutes is not a long time to explain the problem of "too much medicine," to share what is already being done and to inspire and create a call to action. Fortunately, I have the opportunity to speak at other events including the SRPC's Rural and Remote conference in April in Montreal as well as at the St Paul's Family Medicine course this November in Vancouver.

    To find out more about my past and future talks, look at the Media/Talks section.

    Source: https://prezi.com/bpguaxve_yyx/ubc-cpd-50t...

    CONFERENCE: ISDM/ISEHC2015: Bringing Evidence-Based Practice and Shared Decision-Making Together

    What could be better than a conference combining evidence-based practice (EBM) and shared decision making (SDM)!? 

    A conference combining EBM and SDM... in Australia!!

    That's right, July 19-22, the University of Sydney will be hosting the joint international shared decision-making (ISDM) and International Society for Evidence Based Health Care (ISEHC) conference.

    Drs Paul Glasziou (@PaulGlasziou) and Lyndal Trevena (@LyndalTrevena) host, with keynote speeches from Drs Victor Montori (@VMontori), Alexandra Barratt (U of Sydney, organizing committee of Preventing Overdiagnosis), and Sharon Strauss (U of Toronto).

    Submit an abstract today! Early bird registration will open soon, and close April 17, 2015. Check out the website and subscribe to their email list so you know as soon as registration opens.

     

    Find out about other conferences and events on the subject of Overdiagnosis, the application of evidence and shared decision-making, and Less is More in Medicine.

    REGISTER: 50th Annual Post Grad. Review in Family Medicine (Vancouver)

    Interested in updating your core family practice knowledge?

    Want to hear about the Choosing Wisely campaign, or some 'next steps' if you're already an expert? 

    I'll be speaking at The University of British Columbia (UBC) Continuing Professional Development (CPD) 50th Annual Post-Graduate review in Family Medicine. I was asked to speak about the Choosing Wisely Canada Campaign and it's an exciting opportunity to share my passion for this and other initiatives within the movement towards appropriateness in care.

    As some of the audience may already be familiar with the campaign and using it regularly, I will also offer some "next steps" ideas for these keeners.

    My talk, "Choosing Wisely (& Beyond): Starting Conversations Around Unnecessary Tests and Procedures " is at 11:05 on Tuesday, February 25th. To see slides/handouts from my previous talks or to see scheduled upcoming talks, go to the MEDIA/TALKS section of the site.

    The Post Graduate Review is a pretty high-yield, practical sort of CME event and knowing some of this year's speakers, I can say I'm really looking forward to talks on Palliative Care, Interesting Cases in Rheumatology, Counselling Anti-Vaccine Parents, Weight Loss in Obesity, and many more! [Sadly I'll miss some of them as my partner's vacation starts on the 26th and we'll be off adventuring, but when it comes to vacation, more is more ;) ]

     

    Hope to see you there! (See the brochure and registration form or register online)