Dialogue Volume 13 Issue 4 2017 - Page 41

PRACTICE PARTNER Avoid the diagnostic cascade Conversations are the test to Practising Wisely DOC TALK By Stuart Foxman W hen he came to Dr. Jobin Varughese complaining of palpitations, the patient already had his own recom- mendation: send me for a screening EKG. “He had Googled it and thought this was the way to go,” says Dr. Varughese, a family doctor in Brampton. Earlier in his career, Dr. Varughese may well have obliged. “I was a lot more trigger happy,” he admits. He wouldn’t fault any colleagues for ordering an EKG under the same circumstances – but only after an hon- est conversation with the patient. In this case, the patient was young and healthy with no previous coronary issues. As Dr. Varughese probed, it became clear that the palpitations occurred when the patient was stressed. His caffeine intake was also high. Dr. Varughese talked about the pros and cons of an EKG. The discussion raised the point that if something was even slightly off it might spark more tests. In the end, Dr. Varughese and the patient agreed that an EKG would likely yield nothing helpful and was, for now, needless. The vast majority of his diagnoses and ad- vice, says Dr. Varughese, results from patient physicals and histories. Doctors and patients alike can be tempted – often to their detri- ment – to turn to the abundance of tests and treatments available. “If it’s not going to be clinically useful or beneficial, don’t do it,” says Dr. Varughese, co-chair of the Practising Wisely Planning Committee. Practising Wisely, a program of the On- tario College of Family Physicians, is aligned with the Choosing Wisely campaign. That national effort was launched in 2014 by a team from the University of Toronto, Cana- dian Medical Association and St. Michael’s ISSUE 4, 2017 DIALOGUE 41