Wednesday, December 17, 2014

Medical groups produce list of overused tests in ‘Choosing Wisely’ campaign

TORONTO — A new campaign has been launched that aims to give Canadians appropriate medical care, but not excessive care.
Called Choosing Wisely Canada, the campaign is enumerating the myriad tests, treatments and procedures that can be overused in modern medicine. The goal is to get doctors to order these tests or treatments when they are needed, but only then.

“We want people to get the tests they need, but we want them to not get the tests they don’t need, or the treatments they don’t need,” said Dr. Wendy Levinson, chair of the campaign, which is tailored after a similar campaign that was launched in the United States two years ago.
Choosing Wisely Canada is funded by the Canadian Medical Association, the University of Toronto, the Ontario government and several other organizations.
Nine national medical organizations have drawn up lists of overused tests and treatments within their specialties, and more groups are at work doing the same, said Levinson. At this point, there are 40 tests and procedures on the organization’s website, www.choosingwiselycanada.org.
For example, the Canadian Association of Radiologists brought forward the recommendation that doctors should not order imaging tests for lower back pain unless there are red flags that suggest cancer, infection, a suspected compression fracture or something equally serious.
Likewise the radiology group recommended doctors not order imaging tests for uncomplicated headaches, unless there are red flags, and to use ultrasound as a first option for testing for appendicitis in young children, because it exposes them to less radiation than CT-scans.
The Canadian Cardiovascular Society recommended that doctors not order stress tests for patients who don’t have cardiac symptoms, unless there are troubling signs. They also suggested doctors not order annual ECG — electrocardiograms — for low risk patients without symptoms.
And the College of Family Physicians of Canada recommended doctors not prescribe antibiotics for upper respiratory infections — influenza-like illnesses or sinusitis — that are likely caused by viruses. Antibiotics do not work against viruses.
Levinson admitted weaning doctors and patients off unneeded medical tests will require culture change. As it currently stands, she said, patients who leave a doctor’s office without a prescription or an order for a test may feel they haven’t received medical care.
“We really need to, over time, change this conversation and help people to understand and trust that sometimes less is more,” Levinson said.
She insisted the effort is not rooted in a desire to save money or ration care.
“We’re not telling physicians not to order these tests,” Levinson said.
“None of these recommendations are ‘Don’t order them.’ It’s ‘Don’t order them when they’re not needed. But order them when they’re needed.”’

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