Ten Commandments for patient-centred treatment | British Journal of General Practice

One of James' slides from a talk we did with an older version of the commandments

One of James' slides from a talk we did with an older version of the commandments

I first encountered the 10 New Therapeutic Commandments when I started working with James McCormack on a lecture for medical students at the University of British Columbia.

Evolving from the chapter ‘The new therapeutics. Ten commandments’ by John S Yudkin in The Good GP Training Guide, they've developed into something completely wonderful.

I expect these capture the practice philosophy of most people who are interested in "Less is More" and "Choosing Wisely," and looking at them now, I think perhaps we should have devoted the entire lecture to this one slide.

See for yourself, the list and explanations, in the British Journal of General Practice.

 

My top 3 from the 10

1. Thou shalt have no aim except to help patients, according to the goals they wish to achieve

I think this could be the modern version of the most eminent aspect of the Hippocratic oath; not doing harm becomes respecting patient goals above all else)

2. Thou shalt always seek knowledge of the benefits, harms, and costs of treatment, and share this knowledge at all times

It is impossible to have an informed discussion and consent if one isn't informed.

7. Honour thy older patients, for although they often have the highest risk, they may also have the highest risk of harm from treatment

Exactly.

. . . 

Look at the list to see the rest!

 

Source: http://bjgp.org/content/65/639/532

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)

BCMJ: Measuring and improving quality of care in family practice

With about 400 articles on the subject of "Less is More" overdiagnosis, overtesting, overtreatment, undertreatment, etc. in my Instapaper queue, I figured I should start tackling them again with brief précis or reflective posts so that you can have the benefit of my curating.

I'll probably alternate between older foundational articles and new interesting stuff.

Today: a new article in the British Columbia Medical Journal (BCMJ) by Dr. Martin Dawes, head of Family Practice at UBC, my alma mater.

Quality assurance for family practice should be determined locally and provincially, with a distributed model of quality assurance for the province rather than a centralized model, to increase the likelihood of positive change in response to variations in practice.

Dr Dawes captures it well when he writes of the need for a quality measurement system which takes into account appropriate variations in practice, and that such a system must flex and be  adjusted as we understand more about the meaning of the data we are collecting.

I was glad to see that Dr Dawes, unlike many others, doesn't put all the weight solely on achieving  "targets." It's not that guidelines and clinical measures should be forgotten about, however they are but one part of the larger quality picture and fortunately he spells this out. I worry that governments and health authorities have not yet arrived at this way of thinking.

While I appreciate that things like accessibility are mentioned in the article, I do note the lack of emphasis on (or even mention of) the role of a strong relationship or attachment between doctor and patient in high quality care. Hopefully this is something that decision-makers are well-aware of, and they take it so for granted that they don't explicitly mention it in their articles.  :P

This article is a timely piece as physician organizations, health authorities, and governments in Canada begin the discussion about 'what is good care?', 'how can we measure it?', and 'what can we do to make it better?'

Read more in the BCMJ.

Source: http://bcmj.org/premise/measuring-and-impr...