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CMA throws weight behind Choosing Wisely project: “Brilliant in its simplicity”

The CMA and eight specialty societies have thrown their collective clout behind a first-in-Canada initiative designed to change the way Canadian physicians and patients approach the use of diagnostic tests, treatments and procedures.

Through Choosing Wisely Canada, which was launched April 2, the specialty societies have each released evidence-based lists containing five tests, treatments and/or procedures that may be overused within their specific specialty. The goal is not to stop their use, but to encourage physicians and patients to question whether such use is necessary.

The Canadian project is based on Choosing Wisely, which was launched in the US by the ABIM [American Board of Internal Medicine – Ed.] Foundation two years ago.

If the American experience is any example, Choosing Wisely Canada can expect to grow rapidly — the American body now has more than 60 participating specialty societies.

CMA President Louis Hugo Francescutti described the Choosing Wisely concept as “brilliant in its simplicity” when he discussed the Canadian project.

“The message is simple,” he said. “More is not necessarily better when it comes to medical treatment, and some tests may even be harmful. For instance, why expose yourself to radiation from an X-ray, even at relatively low doses, if you don’t need to?”

Francescutti said a shift in attitude is overdue. “Society has developed an underlying belief that more is always better when it comes to medical treatment, and we want to change that attitude among both health care professionals and their patients.”

In the US the effort is already well under way — by February 2014, the 60 participating specialty societies had highlighted 260 tests, procedures and treatments that should be approached cautiously because of their potential for overuse. (When Choosing Wisely lists were first circulated in the US in 2012, only nine specialty bodies participated.)

Dr. Wendy Levinson, a Toronto physician who has been a driving force behind the launch of Choosing Wisely Canada, says discussions have already been held with 30 Canadian specialty societies, and eight of them (Canadian Society of General Surgeons, Canadian Association of Radiologists, Canadian Cardiovascular Society, Canadian Geriatrics Society, CMA Forum on General and Family Practice Issues/College of Family Physicians of Canada, Canadian Orthopaedic Association, Canadian Rheumatology Association and Canadian Society of Internal Medicine) will be releasing their lists April 2.

Some random examples drawn from those Canadian lists include:

  • Don’t use Pap smears to screen women under 21 years of age or over 69 years of age.
  • Don’t routinely perform preoperative testing (such as chest x-rays, echocardiograms or cardiac stress tests) for patients undergoing low-risk surgery.
  • Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.

“For many years, both physicians and patients have had a ‘more is better’ attitude,” Levinson and colleague Tai Huynh wrote in a recent CMAJ commentary. “It is time to adopt a ‘think twice’ attitude and to avoid unnecessary and potentially harmful tests, procedures and treatments.”

Francescutti agrees. “This isn’t about rationing and it’s not about cost-cutting,” he says. “Choosing Wisely Canada is about changing medical culture and patient perceptions — we simply want to give patients the best care possible.”

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