Family medicine recommendation 5
Do not do annual screening blood tests unless they are directly indicated by the risk profile of the patient.
How have you implemented this recommendation in your practice?
This is the broadest and biggest recommendation I am focusing on because I have quite a young professional population. They are health conscious and a lot of them wonder, “What do I need?” This is when I open up the conversation about necessary care.
I have the Choosing Wisely posters in my examination rooms and the list of guideline-based screening maneuvers next to them. I usually talk about screening maneuvers and then explain the ones that are applicable to that patient. I explain that most of the time at their age they are not going to need bloodwork. This is the best recommendation to talk about for me—why you do not need blood tests if you are well.
How have you brought the Choosing Wisely principles to your relationship with patients?
I am introducing them to the concept when I first meet them. I have a new practice and I take on about 5 new patients daily.
Most of my conversations around appropriateness of care are very positive. My practice is in downtown Calgary, Alta, and I have quite a variety of patients— everything from homeless people to lawyers and engineers—and they really appreciate having the conversation about what is necessary. They appreciate that their intelligence is being respected. I am being more inclusive; they are able to engage in a 2-way dialogue about their health. I think the days when people trust physicians at face value are over. People are increasingly sensitive to the concept of harm. Everyone knows someone who has had a bad outcome in their medical care.
What does Choosing Wisely mean to you as a family physician?
It is helping us to think twice about what we are doing and also to be better custodians of resources. People are being more environmentally conscious; they are more aware of economic factors and constraints. I think now we are showing leadership in medicine. It is helping the profession to be more accountable to patients.
Notes
Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments, and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. To date there have been 11 family medicine recommendations, but many of the recommendations from other specialties are relevant to family medicine. In each installment of the Choosing Wisely Canada series in Canadian Family Physician, a family physician is interviewed about how he or she has implemented one of the recommendations in his or her own practice. The interviews are prepared by Dr Kimberly Wintemute, Primary Care Co-Lead, and Hayley Thompson, Project Coordinator, for Choosing Wisely Canada.
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