HFHT's Practising Wisely Newsletter
For clinicians, by clinicians.
Issue 26: Reflections on 25 Episodes of Choosing Wisely
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June 20, 2017

Hardly a week goes by without another headline in the newspaper or on social media about the millions of dollars being wasted in our health care system. We are faced with huge paradigm shifts in the way we practice - EMR, quality improvement, patient choice, evidence based medicine.

So, understandably, it is difficult to change and incorporate new information into our everyday workflows. A couple of recent articles highlight some of these difficulties:

There was a systemic review published in JAMA in March of 2017 called Clinician’s Expectations of the Benefits and Harms of Treatments, Screening and Tests (see Quick Links section for a link to the abstract). While clinicians generally did not have accurate estimations of harm or benefit, more importantly they more often underestimated harms and overestimated benefits. Inaccurate perceptions about the benefits and harms of interventions are likely to result in sub-optimal clinical management choices.

Click the graphic above to enlarge

The rather busy graphic from the article highlights the degree of over and under estimating benefit from various treatments and tests.

Interestingly, The Surgical Forum of Great Britain and Ireland, in their Choosing Wisely forum in 2016, looked at reasons for the profession’s propensity to over-investigate and over-treat:

  • To provide reassurance
  • A need to exercise trained skills
  • Fear of litigation
  • The illusion of communication

I am sure we can all add reasons for ordering a test or prescribing a medication.

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