Choosing Wisely Canada: 3rd Wave of Reccomendations

Choosing Wisely Canada has released their 3rd wave of recommendations!

Groups like the Canadian Association of Emergency Physicians (CAEP), Canadian Society of Hospital Medicine (CSHM), three psychiatry groups (Canadian Academy of Child and Adolescent Psychiatry, Canadian Academy of Geriatric Psychiatry, Canadian Psychiatric Association) and three surgical groups (Canadian Spine Society, Canadian Society for Vascular Surgery) have all developed lists of the top things that patients and doctors should question. The Canadian Society for Transfusion Medicine also added 5 new recommendations. See the new recommendations here.

This round was particularly interesting for me as I got to witness the process of the development of the CSHM list and participate in some stages, though not extensively. It's a tough task, whittling down all the ideas to find well-evidenced items that represent key areas for improvement, and try to avoid duplication of other specialty society recommendations. The group has to consider that many things which are good ideas and really really important to tackle, may not be suitable as the evidence behind them may be vague.

For example, though we all felt that discussing 'goals of care' or advance directives and resuscitation statuses (eg. DNR) with patients is very important, there's little data about why/how/when this should happen and what impact it actually has on patient well-being. Should it be discussed by the hospitalist? The GP? On all admissions? Only when a patient's status changes?

Ultimately it was impossible to make a firm statement that was robustly rooted in evidence, though our 'gut' feeling was strongly that we need to be having these discussions and that patients and doctors both should be starting conversations on the subject.

Choosing Wisely, as ever, forms a great starting place for discussing overuse of harmful and unnecessary tests and treatments. Yes, some of the recommendations are 'low-hanging fruit' but we have to start somewhere, and Choosing Wisely is great at getting us started talking about the facts that "more is not always better" in medicine.


VIDEO: Choosing Wisely and Encouraging Effective Treatment

Healthcare Triage briefly presents the notion that we should "stop doing things that don't work" in medicine. In the United States, vast amounts of money are being wasted on unnecessary care. Fortunately, the Choosing Wisely campaign helps enable patients and providers to take part in "reducing spending without negatively affecting quality of care."

In Canada, it is framed a little bit differently. We focus mostly on preventing harm and promoting high quality care. We expect that there will be significant financial benefits to the system from working in this way but saving money is not the primary motivation behind the Choosing Wisely Canada campaign. 

There are also some things the campaign (whether in the US, Canada, or elsewhere) doesn't address, like the fact that people respond to financial incentives and if we do not change the way health care providers are paid, they will continue to do unnecessary things to patients simply for the monetary gain (in direct violation of medical professionalism and most would say the Hippocratic Oath).

See the video here:


2nd Wave of #ChoosingWisely Canada Recommendations

Choosing Wisely Canada has just released their second wave of recommendations.

If you've been snoozing under a rock, Choosing Wisely is a physician and patient-led campaign to encourage discussions about unnecessary tests and treatments during clinical care.

National specialist societies got together, reviewed the evidence, and created Top 5 (ish) lists relating to things doctors and patients should do less of.

This round, there are recommendations from many groups. Here are a few juicy examples:

From The Canadian Association of Medical Oncologists & Canadian Partnership Against Cancer [full list of 10], eg:

An updated list from CMA’s Forum on General and Family Practice Issues and College of Family Physicians of Canada [full list of 10], eg:

From the Canadian Association of Pathologists [full list of 5], eg:

(See Myths and MSUs for more on this)

These lists are a great start! I was so pleased to see that some of the recommendations really "have teeth." That is to say, the organizations tackled some areas where myths and controversies persist, as change is clearly needed.

I am excited to see the Patient Materials section expand because the tools there will be one of the most important parts of this campaign, which is all about empowering and informing patients.