EBM - Choosing Wisely

Question 1

What is the Choosing Wisely campaign?

Answer 1

A campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments and procedures.

Question 2

3 principles of Choosing Wisely

Answer 2

• Harm reduction
• Resource stewardship
• Shared decision-making

Question 3

What percentage of care is unnecessary, appropriate or neglected?

Answer 3

Unnecessary care: 30%
Appropriate care: 55%
Neglected care: 15%

Question 4

What is unnecessary care?

Answer 4

Clinical activity (treatments or diagnostic interventions) that have been shown by the evidence not to provide meaningful benefit.

Question 5

What is low-value care?

Answer 5

A healthcare practice providing minimal benefit to recipients

Question 6

Recommendation 1: Don’t suggest the ordering the most … before considering …

Answer 6

Don’t suggest ordering the most invasive test or treatment before considering other less invasive options.

Question 7

Recommendation 2: Don’t suggest a test, treatment or procedure that will not…

Answer 7

change the patient’s clinical course

Question 8

Recommendation 3: Don’t miss the opportunity to initiate conversations with patients about whether a test, treatment or procedure is…

Answer 8

necessary

Question 9

Four questions patients should ask themselves (choosing wisely campaign)

Answer 9

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?

Question 10

Recommendation 4: As a medical student, don’t hesitate to ask for clarification on…

Answer 10

tests, treatments or procedures that you believe are unnecessary

Question 11

True or false? Patients tend to overestimate the benefits of clinical procedures and underestimate harms.

Answer 11

True!

Question 12

True or false: Physicians tend to overestimate the benefits of clinical procedures and underestimate harms.

Answer 12

True!

Question 13

Recommendation 5: Don’t suggest ordering tests or performing procedures for the sole purpose of …

Answer 13

gaining personal clinical experience

Question 14

Recommendation 6: Don’t suggest ordering tests or treatments pre-emptively for the sole purpose of anticipating…

Answer 14

what your supervisor would want

Question 15

True or false: We should perform colorectal cancer screening on asymptomatic patients with a life expectancy of less than 10 years and no family history of colorectal neoplasia.

Answer 15

False! We should avoid it.

Question 16

When should we not recommend cancer screening?

Answer 16

In adults with life expectancy of less than 10 years.

Question 17

What leads doctors to provide care that will confer little or no benefit to patients?

Answer 17

1. Patient demand
2. Clinical habits (routines)
3. Lack of knowledge
4. Fear of litigation

Question 18

What is over-diagnosis?

Answer 18

When people without symptoms are diagnosed and then treated for a disease that won’t ever cause them any symptoms.
AND
When people whose symptoms or life experiences are given a diagnostic label which brings them more harm than good.

Question 19

How does over-diagnosis usually happen?

Answer 19

When asymptomatic people are screened (esp. prostate, breast, thyroid and renal cancers)

Question 20

Explain the popularity paradox of screening

Answer 20

When more people are screened (and a % is over-diagnosed), more people feel they owe their life to screening.
That makes screening more popular, so even more people are screened (vicious cycle).