VIDEO: Good Stewardship / Model conversations with patients about overtesting and overtreatment

The National Physician Alliance (NPA) has done a lot of work in the area of preventing overdiagnosis and empowering patients to find the right amount of care. They are a partner in the Tandem Health project/app, created Top 5 lists (in good stewardship) which served as a model for the Choosing Wisely Campaign, and promote responsible prescribing (by limiting influence of the pharmaceutical industru) through The Unbranded Doctor.

Created in 2011, this video is a timeless tool for Good Stewardship. It gives a simple, 5-step plan of how health care providers can discuss unnecessary tests and treatments with patients.

They suggest:

1. Clarify what the patient’s true concerns are
2. Provide the patient with the information he/she needs to understand the plan
3. Be courteous and respectful
4. Provide clear contingency plan
5. Make sure the patient is satisfied with the plan
Source: https://www.youtube.com/watch?v=kh7EKP9wSg...

Must Watch VIDEO: (TEDMED) Are zombie doctors taking over America?

I don't know how I hadn't already seen this. It is perfect.

I've been feeling lately that it is impossible in this system to deliver good quality care and to be 'happy and well and fulfilled' myself, I can related to almost everything Dr Zubin Damania (aka ZDoggMD) says in his TedMed talk.

For years I've enjoyed ZDoggs hilarious videos but for some reason I did not see his TED talk until today.

Physician Zubin Damania, Director of Healthcare Development for Downtown Project Las Vegas, has a plan to fight back against a system that can dehumanize doctors and patients alike.

So much of what he says about his journey into medicine resonates with me, but this one section captures it all perfectly:

"A typical day in my life went something like this:

It begins with a mad scramble from room to room seeing complicated, sick and scared patients and their families, followed by three hours of paperwork using an electronic medical record that's two keystrokes away from becoming sentient and destroying humanity, all the while answering phone-calls from insurance companies, colleagues, and administrators each asking that I do more and more with less and less while improving quality and patient satisfaction. And speaking of which, that patient for whom I refused Vicadin because I was convinced it was destroying his life just ripped me a new one on Yelp! And I get through my 31st voice mail and I'm trying to delete it and it won't delete and I'm thinking I have to call I.T. now and I realized the reason it won't delete is that it's a live person I'm talking to. And it's my wife. And she's asking me to come home.

When I finally do get home, I can't be present with my two little girls because all I can think about is 'could I have missed something in this insane shuffle that could hurt or kill somebody?' Later, rinse, repeat for an entire career."


"Enough was enough. I realized I had a choice to make. I could either submit to this insane system and retire and then do my thing, but have my soul crushed and join the ranks of the swelling physician-zombie apocalypse. Or, I could surrender.

Just give up the external validation, drop the mask, and really surrender to who I actually was and have some hope of reconnecting to my purpose."


I need to do that. Dr Damania and Iora Health understand the fundamentals of providing the right kind of care. If we weren't wasting so much time and energy on all kinds of things that don't really matter, we could start to care for people again.

How can we do it?

- remember "medicine is about human relationships"
- "fix the reimbursement system . . make it an affordable, flat fee that incentivizes everyone to keep everybody well."
- "revolutionize the care model and the culture of the team; health coaches, nurse practitioners, doctors, and patients working together collaboratively non-hierarchically to change the health of the whole community"
- "glue it together with technology that helps rather than obstructs
- "do things FOR people instead of TO people"

I want to be a part of a clinic like that!

Source: http://www.tedmed.com/talks/show?id=34752

Choosing Wisely Canada extra resources

Being part of the Early Adopters collaborative for Choosing Wisely Canada, I've been made aware of some really useful resources that you may not have heard of yet.

Thanks to Tai Huynh (Campaign Manager) and Karen McDonald (Project Manager) with Choosing Wisely Canada for allowing me to share their commentary and these great links:

1.     Canadianized patient pamphlets

In collaboration with Consumer Reports Health and Canadian medical specialty societies participating in Choosing Wisely Canada, we have (to date) released 25 lay language patient pamphlets to help educate patients and facilitate provider-patient conversation on tests, treatments and procedures that may not be necessary. These pamphlets can be found in the materials section of the Choosing Wisely Canada website  and are downloadable as PDFs. The generic patient pamphlet contains four questions patients are encouraged to ask their doctors.

 2.     Instructional videos to help providers and patients think and talk about overuse

The ABIM Foundation funded the Drexel University College of Medicine to develop a set of interactive instructional modules to enhance physician and patient communication around the specialty society recommendations from the Choosing Wisely campaign. Developed in collaboration with nine medical specialty societies, these modules are designed to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources by providing strategies for physicians to build trust and address patient attitudes and beliefs that more care is not always better care.

These videos can be accessed from the US Choosing Wisely website, modules section. They are a bit tricky to locate, so here are some examples: 

3.     Washington State Choosing Wisely Task Force toolkit

A PDF of the Washington State toolkit created for physicians or other health care leaders struggling with how to integrate Choosing Wisely’s evidence based best practices into their practices or organizations.

4.     Spreadsheet of Canadian physician recommendations

A spreadsheet containing all 102 CWC recommendations released to date is attached and can be downloaded from our website http://www.choosingwiselycanada.org/recommendations/