PRACTICE PARTNER
the annual physical to become a periodic
health review (poly pharmacy in the elderly
and over-monitoring for diabetes).
The workshops were launched in 2011,
before Choosing Wisely was established.
Dr. Jennifer Young, who helped to develop
the original curriculum, says the course has
been redeveloped since to enhance its impact
and address all seven of the CanMEDS
physician roles (medical expert; communica-
tor; collaborator; manager; health advocate;
scholar; and professional). Participants earn
professional development credits.
In November 2017, the OCFP held its in-
augural Practising Wisely Day in Toronto, of-
fering a full day of learning around reducing
over-prescribing, over-imaging, over-screening
and over-monitoring. One test can lead to
another, increasing risks and patient unease.
Dr. Young calls it “the diagnostic cascade”.
Framing the discussion around tests isn’t a
matter of doctors saying “we must do this” or
“we shouldn’t do this”, but of talking about
evidence and grasping the patient’s mindset.
Take something like prostate cancer. The
Canadian Task Force on Preventive Health
Care looked at PSA tests. They found that
the potential small benefit is outweighed by
the possible significant harms of the screen-
ing and associated follow-ups (like biopsy
or treatment complications). The Task Force
says men should know that screening may
result in additional testing if the PSA level is
raised. Among men screened with the PSA
test, the risk of dying from prostate cancer is
5 in 1,000; among those not screened, that
risk goes to just 6 in 1,000.
Different doctors have different outlooks
on PSA screening. So do different patients.
What’s the right thing to do? Talk openly
about the disease, symptoms, risks and how
the patient is feeling. Is he stressed because
he wants the test or because he doesn’t? Does
he know other people who’ve had the screen-
ing, and is that influencing him? Whatever
the variables, the doctor is there to help
guide, not dictate. “I’m the advisor, I work
for the patient, so it’s a shared decision,” says
Dr. Kuling.
As Dr. Varughese explains, in