Choosing Wisely Canada Talks

Earlier this month, I participated in a Choosing Wisely Canada Talks webinar. Drs Kimberly Wintemute and Anthony Train shared insights around a clinician's professional obligations and led a discussion around practical tips for having conversations with patients in these scenarios. You can see their talk and others in the Choosing Wisely Canada Talks series online.

This primary care discussion was incredibly relevant, and we covered a few tough topics including:

  1. A healthy patient requesting non-indicated screening blood work
  2. A patient requesting unnecessary imaging eg. MRI for lower back pain
  3. When a naturopath has told patient to ask MD to order a series of blood work
  4. A patient with a viral infection insisting on antibiotics
  5. Chronic use of sedatives/hypnotics including benzodiazepines in an older patient

It was great to have a mixture of people, including a patient voice, in the webinar. Some of the themes that emerged were around building a trusting relationship, exploring the patient's fears or goals and addressing those, having a discussion about risks vs benefits, using analogies/humour to convey a message, and using physical exam and other techniques to reassure patients.


"Choosing Wisely Talks take place on the 1st Thursday of every month from 12pm-1pm ET. Each workshop is led by an inspiring guest speaker, usually someone who has made significant gains in implementing the Choosing Wisely recommendations. Through a webinar format, participants tune-in to a live presentation by the guest speaker, followed by an interactive Q&A discussion. Participants usually leave each workshop with:

  • A greater appreciation for the impact of overuse
  • Ideas and inspiration for their own Choosing Wisely implementation project
  • A better grasp on potential barriers and opportunities to successful implementation"

 

Go to the website and use the right-hand menu to add these valuable events to your calendar or sign up for the newsletter. The next session is November 3rd from 12-1PM Eastern Time.

New Choosing Wisely toolkit with patient handouts - Family Medicine, CFPC

The College of Family Physicians of Canada (CFPC) and its Patient Education Committee (PEC) are pleased to release a new Choosing Wisely Canada™ (CWC) toolkit. This innovative initiative is aimed at educating the public about anticipated changes in how family physicians approach health care prevention.  

Building on the success of the CWC campaign, the CFPC launched a whiteboard video titled Do More Screening Tests Lead to Better Health? This video was developed by the Dr. Mike Evans Lab group and focuses on a number of common screening tests: vitamin D malabsorption, mammography, thyroid testing, chest X-ray and electrocardiograms, Pap smears, dual-energy X-ray absorptiometry (DEXA), and annual physical exams.

The new CWC toolkit provides the following resources: 

Please see www.cfpc.ca/ChoosingWisely for more information, and if you want to see patient handouts and shared decision-making tools from other sources, check out the Less is More Hands On Tools page.

 

Toolkits from Choosing Wisely Canada

At the Choosing Wisely national meeting March 30th, Choosing Wisely Canada (CWC) announced a new direction.

In lieu of the 10 million challenge, they are instead putting significant effort into empowering CWC enthusiasts by way of facilitating "DIY Toolkits."

These tool-kits are PDF documents, starting with a catchy title and cover art (provided by CWC), and filled with user-generated content, meant to enable you to apply some of the Choosing Wisely recommendations to your institution or practice. So far, the topics include reducing unnecessary indwelling (Foley) catheter use, proton-pump inhibitor prescriptions, 2nd units of red blood cell transfusions, pre-operative investigation, and sedative/hypnotic use in the elderly.

Click on the image below to check out the first 5 or go to the page to learn how to submit your own:

Source: http://www.choosingwiselycanada.org/in-act...

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

VIDEO: Do More Screening Tests Lead to Better Health? @docmikeevans

Many of you will be familiar with the hilarious and helpful work of Dr Mike Evans and his team. Their white board videos are a great blend of up-to-date evidence, patient perspective, and useful advice.

In Do More Screening Tests Lead to Better Health? you'll find more than just the answer to that question ("No.").

With a focus on healthy, well-feeling, average risk individuals, the video emphasizes that the harms of doing a test (and the sequelae of that test) may be greater than the benefit. This is a tough bit of information to accept particularly if you've already had lots of 'preventative tests' done and have felt reassured by them. However, it's really time to re-evalute their usefulness.

It's not that we should do nothing to prevent disease; instead of wasting a person's time and resources on unnecessary tests, the time can be better spent devoted to support around lifestyle choices that we know will lead to better health. Take a look:

Source: https://www.youtube.com/watch?v=8c7qTsVVxX...

The Most Important #ChoosingWisely List: Med Students & Trainees

Please join me in enthusiastically applying the latest Choosing Wisely Canada recommendations, as developed by the Canadian Federation of Medical Students (CFMS) and the Fédération médicale étudiante du Québec (FMEQ).

This amazing list of 6 items for Medical Students and Trainees to question is extremely important. It does a few things above and beyond what the other Choosing Wisely Canada lists could. Namely, the list:

  • Creates and promotes a culture of appropriateness in care early on in the careers of physicians, ensuring this way of thinking is embedded in their style of practice
  • Recognizes the professionalism, critical-thinking ability, and ethical intelligence of young clinicians
  • Engages medical educators and recognizes the mutual influence that learners and instructors can have on each other's practice
  • Is directed squarely at providers; while discussion between patient and provider may seem notably absent, each of the items is patient centred at a high-level; the list ensures that the goals of the patient – not the learner – are paramount, and that the learner will advocate in this regard

Hopefully the Students and Trainees Advocating for Resource Stewardship (STARS), students selected to champion the Choosing Wisely campaign, will be able to integrate these Top 6 into their medical schools' curricula.

Congratulations to the members of CFMS, FMEQ, and STARS on this fantastic work.

Review the 'Six Things Medical Students and Trainees Should Question' list.

Source: http://www.choosingwiselycanada.org/recomm...

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...

VIDEO: What causes antibiotic resistance? Kevin Wu | TED-Ed

It is goofy (there are butt-faces, silly monsters, Salmonella shooting lasers, and even a fart scene at 2:22) and informative. It is bound to be a classic!!!

Watch this fun video explaining What Causes Antibiotic Resistance thanks the Kevin Wu and Ted Ed.

View full lesson: http://ed.ted.com/lessons/how-antibiotics-become-resistant-over-time-kevin-wu Right now, you are inhabited by trillions of microorganisms. Many of these bacteria are harmless (or even helpful!), but there are a few strains of 'super bacteria' that are pretty nasty -- and they're growing resistant to our antibiotics. Why is this happening?

Source: http://ed.ted.com/lessons/how-antibiotics-...

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)