CONFERENCE: Hellish Decisions in Healthcare Jan 2017

Hellish Decisions in Healthcare is designed as a space for healthcare leaders, professionals and researchers within the international healthcare community to shape healthcare policy and systems to deliver Triple Value.

  • Personalised value, the delivery of services informed by what matters to the individual

  • Technical value, determined by how well resources are used within services for each purpose

  • Allocative value, determined by how the assets are allocated to services for different purposes.

The decisions and strategies needed to deliver Triple Value will not always be immediately apparent and nor will they be easy to make; the Value in Healthcare Forum is a safe place where these strategies can be developed and where strategic discussions can be had with the key thought and implementation leaders in healthcare.

Read more on the website and do Register by Oct 15 for the Early-Bird Discount.  The event will be in Oxford, Jan 12 to 13th, 2017.


For more events related to "Less is More," "Choosing Wisely," "Preventing Overdiagnosis," "Shared Decision-Making," etc, go here.

 

Source: https://www.phc.ox.ac.uk/events/hellish-de...

Minimally disruptive medicine: Effective Care that Fits Workshop SEPT 2016

I read the fantastic Minimally Disruptive Medicine (MDM) Blog and want to bring your attention to the Mayo Clinic KER Unit MDM event, coming soon:

From the MDM site:

Click on the image to find out more about the Minimally Disruptive Medicine Workshop.

Minimally disruptive medicine (MDM) seeks to advance patient goals for health, health care, and life, using effective care programs designed and implemented in a manner that respects the capacity of patients and caregivers and minimizes the burden of treatment – the healthcare footprint – the care program imposes on their lives.

This site is maintained by researchers at the KER UNIT who are part of an international research team that is working on understanding and implementing MDM across the world.

Some introductions to MDM:
From the peer-reviewed press
From the medical press
From the lay press
From Wikipedia
From a presentation (video) 
From a radio interview (audio)
Complexity Care Model article

 


For more events related to "Less is More," "Choosing Wisely," "Preventing Overdiagnosis," "Shared Decision-Making," etc, go here.

It's #PODC2015 time: Preventing Overdiagnosis 2015 is here

After an incredible General Council (the annual meeting of the Canadian Medical Association), it is now time for me to zip off to Bethesda, MD for Preventing Overdiagnosis.

Although I attended last year in Oxford, this will be my first time speaking at the conference; I have the fortune of working with Dr James Rickert (who challenges conflict of interest in orthopedics and puts the patient first) in order to present a workshop around some of the criticisms (and related solutions) for the Choosing Wisely campaign (at 11:30, Weds Sept 2nd).

I would say that I am Choosing Wisely's biggest fan, and biggest critic. I am looking forward to the opportunity to hear more thought from my peers about the campaign and what the next steps might entail. There is so much hope and opportunity with this initiative and it's a great time to strengthen it and to reach higher!

This conference will also be a great opportunity to reflect on the past couple of years and the progress that so many people have made, and to meet up with colleagues to hear about their planned work going forward. There will be quite a few curious and critical-thinking Canadians in attendance, including (I hear):

-   Dr. Laurent Marcoux (former head of the Quebec Medical Association, one of the key developers of their Action Plan for Overdiagnosis

-    Dr. Roland Grad (researcher in family practice currently looking at harnessing infoPOEMs to identify low-value tests and treatments)

-    Dr. Rita McCracken (finishing her PhD, an expert on polypharmacy/deprescribing in the elderly)

-    Dr. Tracy Monk (humble yet highly effective champion and practicer of patient centered, evidence-based, and relationship-based care)

-    Dr Alan Cassels (co-author of Selling Sickness and highly sensible drug policy researcher)

-    Joanna Trimble (family member and advocate for confronting polypharmacy and sedative overuse in the elderly, at Is Your Mom On Drugs?)

-    Dr. Danielle Martin (head of Canadian Doctors for Medicare and outspoken advocate for doing more with less)

-    Dr Sacha Bhatia (chair of evaluation and can-do pioneer for Choosing Wisely Canada)

-    Dr Jennifer Young (leader of the Don’t Just Do Something, Stand There workshop with the Ontario College of Family Practitioners)

Go Canada!

And that is just the tip of the iceberg. The entire conference will be comprised of like-minded peers from around the world. I can't wait to get started tomorrow; see you there!!!

 

CONFERENCE: Preventing Overdiagnosis 2015 #PODC2015

I registered for this year's Preventing Overdiagnosis conference in Bethesda, MD (near Washington, DC).

You should too, before the spots are all filled up! Last year's in Oxford was incredible. Lots of inspiration, intriguing research and practical solutions to solving this problem on a 1:1 or international level.

If you are interested to see what other events are happening around the subject of 'too much medicine,' the 'right amount of care,' and so on, you can see them on the Events section of this site.

Comment here if there is something missing!

See you in Bethesda :)

 

Source: http://www.preventingoverdiagnosis.net/

PRESENTATION SLIDES: SRPC Rural & Remote Medicine Course: Less is More Medicine

The  handout  for my talk.

The handout for my talk.

The slides from my Society of Rural Physicians of Canada (SRPC) Rural & Remote talk are now available on Prezi.

The handout can be seen here.

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.

This conference had a great number of speakers on subjects related to mine, ranging from Wendy Levinson on Choosing Wisely to Dee Mangin's keynote and workshop about tackling polypharmacy, to some of the hard-hitting EBM stuff from Ken Milne of the BEEMGroup and Mike Allan/Mike Kolber of Tools for Practice. On Saturday we'll hear about antibiotic overuse from Keith White in his session "Put the pen down and back away."

Inappropriate health care (or "too much & too little medicine") is a prevalent issue; it's great to see it being tackled from so many different angles.

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

Source: https://prezi.com/fypbc5slxilc/srpc-rural-...

Day 2 of Road to #RightCare #Lown2015 Recap

This old photo came to mind as I thought about how people tell their stories:   Some graffiti at the skate park in Inuvik, NWT; Is it a profound statement about the way things are imposed on people without ever asking them or listening to them?  Maybe it's just  some teenagers upset about not having enough weed. 

This old photo came to mind as I thought about how people tell their stories:

Some graffiti at the skate park in Inuvik, NWT; Is it a profound statement about the way things are imposed on people without ever asking them or listening to them?  Maybe it's just some teenagers upset about not having enough weed. 

Today was about people.

What I kept hearing today was that patients are people, people have goals and values, and they need to be asked and heard. 

---

We started with Dr Harlan Krumholtz explaining that the right care "is about an informed patient, with an informed choice, based on the right information." Given the real information, a person can decide whether the potential risks or harms of some test or treatment are worth accepting, for the potential benefit of that test or treatment.

Peter Drier, an articulate non-healthcare professional, told his story about being a patient and being the recipient of a (surprise!) $117k bill from a consultant (who he never met) that spent a few hours assisting in the Operating Room. This was in addition to the original agreed upon bill for his surgery. As he told his tale of attempting to navigate a rats-nest of a system that it seems purpose-built designed to bankrupt patients, I was alarmed. Dismayed.

How could you possibly navigate this while also coping with disease? How could vulnerable patients survive in this system? How could doctors ethically accept they were a part of it?

Others in the room thought that getting a patient help to navigate the system would be a good fix. Or maybe publishing prices in a transparent way would help. Wait... what?!

I was shocked to see that people have accepted this system. Rather than challenge the status quo, they seemed resigned to work with it and plan to bodge together some work-arounds and bandaids. Incremental change is sometimes a good solution but when you have a system that toxic, how can you let it persist?

I started really worrying, worrying about the case that surgeon Dr Brian Day has before the BC Supreme Court, which if successful, will pave the way for patients to pay privately for medically necessary procedures. I try to envision a world in which this helps patients, but that future looks like the US of A, and in the US of A, health care is broken, in a far more challenging way than it is in Canada.

But, there are bright spots! In a workshop on designing the future of Primary Care, we learned about the model of the Stanford Coordinated Care Team. It puts patients at the centre and offers them multidisciplinary support to engage them in achieving health, and does so by asking team members to rise within their scope to manage care and build relationships.

Through Beyond Workups and Rule-Outs, we explored the unique drivers of care in the Emergency Room, like time pressures and fear of missing a diagnosis. We brainstormed solutions for the culture and process, and I was pleased to be able to share the (often hated in medical school but valued later in practice) "FIFE" model. This aims to aid patient-centred interviewing, to get at the person rather than the disease or symptoms:

This model forms the backbone of the Family Physician certification exam in Canada.

There were lots of other ideas about helping patients get in and out of the ER "well" and one idea for changing the culture of practice that I really like is "reverse M&M rounds" which may be the same thing as "Right Care Rounds." There was a separate session on this topic I didn't get to go to that session as there was too much simultaneous good stuff; regardless, I am inspired to attempt (time permitting) case rounds back home about inappropriate (unnecessary) care, whether it caused an obvious bad outcome or one that was a bit more subtle.

In the same vein, The Do No Harm Project presented some wonderful 'vignettes' or narratives from residents, highlighting 1) how common medical overuse is and 2) how persuasive a patient's story can be. 

Tomorrow we decide how we will take what we've learned and commit to putting it to work.

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.

Lown Institute Road to #RightCare conference March 8-11, San Diego

I'm sharing this invitation to remind you to register for the Road to RightCare conference. It will be a fantastic look at how to operationalize solutions to overdiagnosis, undertreatment, and the gamut of associated problems. I'll be there too!

If that isn't reason enough, it is a great city! As I'm currently in San Diego, I can tell you that there's plenty to do in you spare time (eg. today we are renting bikes to explore Coronado Island and check out the beach; later we'll taste some great Mexican food and sample some local microbrew). 

With the holidays around the corner, we want to remind you to register for the Lown Institute third annual conference: 

Road to RightCare: Engage, Organize, Transform 
March 8-11, 2015 
Omni San Diego Hotel

Among the many great speakers featured at the conference, you don’t want to miss the opportunity to hear our dynamic keynote speaker, Diane Meier, MD, director for the Center to Advance Palliative Care, Mt. Sinai Health System. If you’ve never heard her speak on a topic of great importance to all of us, here’s a sneak peak

Dr. Meier is one of the many speakers, panelists and attendees who will be addressing our culture of medical overuse in the U.S. and proposing solutions to eliminating it. 

We’re finalizing our meeting agenda and will be sending you weekly updates. We promise that this will be the best conference you’ll attend all year. 

To learn more, see the agendaRegister now. 

. . .

Thank you for supporting and participating in our work. We look forward to seeing you in San Diego. 


Best, 
 

Vikas Saini, MD
President,
Lown Institute

Shannon Brownlee, MSc
Senior Vice President,
Lown Institute
                       

                      

Register Today! 
Click here to visit our website, review the agenda and register. 

Registration Deadline
 February 10, 2015

7 Themes from Preventing Overdiagnosis #PODC2014

In September I was lucky enough to attend the Preventing Overdiagnosis conference in Oxford, UK. I learned about new resources and people that I could connect with, changed some of my beliefs, and generated even more questions for myself/the health care system.

In my reflection, 7 major themes emerged:

  1. Nomenclature

    • under-use is as much an issue as over-use
      • like food, we want our medicine neither over- nor under-cooked [David Haslam]
    • how do we define the problem? what terms are being used to describe this/similar issues? [see glossary for some] can we create a common term?
    • causes of overdiagnosis are on a spectrum
      • good intentions -- wishful thinking -- vested interests [Stacy Carter]
         
  2. Cognitive/Labeling Biases = Problematic

    • flawed thinking: doing something better than nothing, "more is better"
      • the more resources exist, the more they are used
    • actions motivated by fear (of death, illness, uncertainty)
    • labeling bias
      • is there any other way we can see patients besides by labeling them with diagnoses? [William House, Andrew Morrice]
      • creating a "WAR ON CANCER" galvanizes people, breeds an ideology and creates fundamentalists
         
  3. It Is about conversations, not certainties

    • mostly grey areas, no blanket rule for everyone; evidence, guidelines, recommendations must be interpreted for each patient
    • pathology is a continuum, never/rarely yes or no
    • "correct" is not always effective

    • use existing skepticism/understanding to inform others

      • eg. people have begun to understand the harms of the overuse of antibiotics; parlay that into other areas
         

  4. Individuals vs. populations

    • for Patient X to not have a stroke, 76 other people have to be on statins
    • it is not possible to know at an individual level if something is overdiagnosis
    • evidence often does not apply to the person sitting in front of you
       
  5. Health Care delivery is flawed

    • changing the way we delivery primary care might be the heart of the solution
    • "consumer"-driven Predictive, Preventive, Personalized, Participatory (P4) medicine is scary & narcissistic [Henrik Vogt]
    • neo-paternalism may have a role
    • industry is scary
      • for-profit medicine is the biggest enemy of "Less is More Medicine"
      • this drives the medicalization of normal life, which makes us sicker!
    • the technology for genetic-based medicine is a long way off from being helpful
       
  6. Screening fails in ways we never imagined

    • patients equate screening with access to care [Laura Batstra]
    • "why is screening exempt from the ethical responsibilities to do no harm?" [Alexander Barratt]
    • preventative medicine has disappointing outcomes [Linn Getz]
       
  7. Evidence is lacking

    • it's not just a lack of quantity or quality
    • do we really need clinical trials to prove the obvious? can't we just do the right, ethical thing? [Dan Mayer]

Did you take away the same points as I did? Something completely different?

I'm already looking forward to the conference next year, in Bethesda, USA.