Choosing Wisely Canada is, of course, the Canadian version of an initiative of the American Board of Internal Medicine that seeks to reduce the number of unnecessary medical procedures done. In Canada, the campaign will involve voluntary measures to spur both patients and physicians to reconsider the need for procedures that
- are not truly necessary
- are likely to cause harm (or little benefit);
- that duplicate other tests of procedures already conducted; or
- are not supported by evidence;
You will notice that the emphasis seems to vary, with writers emphasizing the harm that can be done by such procedures and the aim of improving patient care. In other cases, the motivation is different. In this internal newsletter for the University of Toronto Department of Medicine from April 2013, Chair Wendy Levinson emphasized the importance of wisely managing scare health care resources and balancing responsibility to individual patients with the need to ensure sustainability of the overall healthcare system. She described it as a question of stewarding finite resources.
Last week, in a Globe & Mail article from this past Friday, Dr. Levinson discusses why unnecessary tests should be avoided, for the good of the patient and simply for good, evidence-based medicine. She specifically says here that Choosing Wisely Canada is not about cost cutting or rationing.
While both goals do indeed overlap, and both seem completely laudable, I would like to read more about the differences in funding models or priorities between the American and Canadian systems. And about how other health care systems, such as that of Cuba--where wise rationing has long been crucial--manage the stewarding of finite resources (and where a different set of assumptions about priorities may prevail). I have also yet to read about how this voluntary, national medical specialty organization-driven initiative is likely to affect provincial health care funding choices or private health insurance claims.
What specific changes do you think we need in order to avoid medically unnecessary tests, treatments and procedures without compromising patient confidence and health?
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