Doctors' grade: C- on #ChoosingWisely Test Your Knowledge Questions in CMAJ

Fascinating results emerge from a small online poll of Canadian Medical Association Journal (CMAJ) readers. Web polls on the CMAJ site were done over the span of 7 months and the following 12 True or False questions were asked.

Although not scientific, the results tell us that (at least mildly-) engaged physicians (those going to the CMAJ website) like to provide a lot of unnecessary and harmful care, particularly in the area of diagnostic imaging.

Not only do we need more research on why physicians think this way, we also need research on what methods are effective at changing behaviours. We don't know yet if Choosing Wisely-type outreach to patients and providers can improve practice. We think and hope so . . .

See the Choosing Wisely Canada update for more.


*NB: Dr S.P. Landry has a keen eye and noticed an error; for the item pertaining to "All children with head trauma require imaging to rule our fracture and brain injuries" the answer should be FALSE. So, the correct response rate would be 70% on that question, making the overall score of respondents a little less terrible, but still remarkably bad ;)


Update: POEMs help identify clinical practices for the Choosing Wisely Campaign

Update: Grad et al's paper is now published! View the full text: Patient-Oriented Evidence that Matters (POEMs) Suggest Potential Clinical Topics for the Choosing WiselyCampaign in JABFM.

[this blog post below was originally published Nov 24, 2014]

It can be challenging to cultivate topics for the Choosing Wisely Campaign; Montréal family physician and researcher Dr. Roland Grad (bio) and his group have found a unique way to harness an existing tool to do so easily.

Dr Grad presented a poster at the Family Medicine Forum (FMF) indicating one way forward could employ physician ratings of Patient-Oriented Evidence that Matters (POEMs).

POEMs are short summaries of relevant and valid information for clinicians. These are free for Canadian Medical Association (CMA) members (login to, click on your name, and go to the Manage Newsletters section) and are basically quick reads with commentary on recent clinical trials, systematic reviews, etc. [Non-CMA members can go to Essential Evidence Plus]

Grad, Pluye, Shulha and Tang focused on one item on the validated questionnaire used by physicians to evaluate POEMs, which asked whether the POEM helped the practitioner in ‘avoiding an unnecessary diagnostic test or treatment’.

They identified the top 20 POEMs in each of two years most commonly associated with helping avoid unnecessary tests or treatment. Interestingly, only 11 of the 40 POEMs had a corresponding item on the Choosing Wisely master list.

[short version: there's a huge collection of already identified practice-changing recommendations just ripe for the adding to a campaign like Choosing Wisely!]

Their process provides an easy way to gather possible topics for future Choosing Wisely lists and could aid in the expert panel approach.

The group's paper is now in the Journal of the American Board of Family Medicine.