More is Not Always Better – Empowering Providers and Patients to Choose Wisely

Did you know that Canadians have more than one million potentially unnecessary medical tests and treatments each year? In medicine, as it is in life, more is not always better. This is the premise of the “Choosing Wisely” campaign.

Choosing Wisely Canada is a grassroots physician-led campaign that has been championed by passionate health care providers from coast-to-coast with a goal to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart choices. Tests and treatments often come with risks and harm. The goal of choosing wisely is to reduce care that is unnecessary and by doing this we ensure we are not subjecting patients to risks or harm needlessly. As well, this allows us to allocate hospital resources where they are needed and best utilized, and this too, improves patient care.

When Choosing Wisely Canada invited hospitals across Canada to join the global movement by making changes, small or large, to reduce overuse, Muskoka Algonquin Healthcare (MAHC) was keen to get involved.

In the fall, we created our Choosing Wisely Committee with physician and staff champions across both sites who began to look at options for how we at the hospitals can do our part to choose wisely and reduce unnecessary tests and treatments.

Through the leadership of the committee, MAHC has implemented five initiatives in support of reducing unnecessary tests and/or procedures, and in January achieved the Choosing Wisely Canada hospital Level 1 designation, joining the ranks of more than a dozen other hospitals across the country.

Both sites received certificates acknowledging MAHC as a Level 1 Choosing Wisely Canada hospital.

These initiatives have brought about positive changes in processes such as a targeted re-evaluation of clinical order sets to ensure they are reflecting current best practices. One of the five initiatives, for example, is to require that all physician orders for daily blood work to have an end date. This helps to avoid unnecessarily repeating blood tests that may not change clinical care, but yet can cause things like hospital-acquired anemia.

There are interesting statistics that tell us that Canadians are mindful of unnecessary health care: 62% agree that there is a significant amount of unnecessary care in the health care system while 92% of Canadians believe patients need more support to know which services are really necessary for their health.

We want patients to also play a role in self-advocating and talking to their care providers about unnecessary care. It’s about education and conversations about when a particular test, treatment or procedure, may be needed and when it may not be.

I implore everyone to consider four questions that we all can be asking our care providers to ensure we are choosing wisely for our care:

1.    Do I really need this test, treatment or procedure?

2.    What are the downsides?

3.    Are there simpler, safer options?

4.    What happens if I do nothing?

We will be using posters in waiting areas and other means like our website and social media channels to spread the choosing wisely word.