Low-value Health Care in Canada — Dr. Guylène Thériault and Dr. René Wittmer

Alya Niang

We analyze Canada’s health care systems and policies in depth, and discuss efforts to keep Canadians healthy by looking beyond the data and talking to experts, health care workers and patients. In today’s program, we take a closer look at how the COVID-19 pandemic has derailed the Canadian health care system, forcing many forms of care to be delayed, cancelled or otherwise affected, a complete shift in priorities in order to care for patients with the infection.

The COVID-19 pandemic has caused major disruptions in the Canadian health care system. Resources have been strained with long waiting lists in the emergency room and for other care. Is it possible to help the overloaded system work better by doing less, fewer tests and procedures that may not really be necessary? In today’s podcast, we’ll talk about Choosing Wisely. A global campaign to stop low-value medical tests and treatments that don’t really help patients and may even harm them. Also, why can the pandemic be an excellent opportunity, a good time to make changes?

Hello and welcome to the Canadian Health Information Podcast. This is Alya Niang, I’m thrilled to be hosting this conversation where we look at our health care system and data with a look at the problems and solutions. Please bear in mind that the opinions and comments of our guests do not necessarily reflect those of the Canadian Institute for Health Information. However, this is a free and open discussion and it focuses on overuse of testing and treatment, the campaign to stop it, and the 5 questions patients can ask to get the best care with the least risk.

Joining us today is Dr. Guylène Thériault, Primary Care Co-Lead of the Choosing Wisely Canada campaign. She is a general practitioner and family physician in Gatineau, Quebec. And Dr. René Wittmer, family physician, president of Choosing Wisely for Quebec, scientific popularizer and assistant clinical professor in the Department of Family Medicine and Emergency Medicine at the Université de Montréal. Welcome.

Dr. Thériault, let’s start with you. I am surprised that more than a third of medical tests and procedures, such as some blood tests, X-rays and medications, may not be of benefit to the patient or may even cause harm. How did we get here?

Guylène Thériault

In fact, we must understand that medicine has been evolving for many decades. In the beginning, we didn’t have many tests or treatments that we could offer to patients. In addition, we didn’t have much data on these tests and treatments. Gradually, this idea that they were useful and could be used for patients took hold. But with the explosion in the number of tests, the number of therapies or interventions that can be done to the patient, we may have forgotten to ask ourselves questions at some point.

But we have been aware of this for 10, 15, 20 years now, I would say that there is probably a problem. Also, not all tests, procedures and treatments are on the same level. There are some that have benefits for patients, for sure, but there are some that don’t. And it depends on the patient as well. The same test may be very useful for one person and not represent something valuable for another depending on why they are going to their doctor.

In fact, what I think is unfortunate is that this idea that not every test and treatment being necessarily useful is not something that is still taught much to health professionals in school. So I think that’s one of the reasons why it’s been going on for so long and why we’re having a hard time getting the message across that, in the end, doing less is probably better for patients.

Alya Niang

Dr. Thériault, one of the reasons we’re hosting this episode today is that the Choosing Wisely campaign and CIHI began tracking certain medical procedures with little benefit back in 2014. We have new data from 2019–2020 that compares how Canada and its provinces are doing on these. What did you find overall and was there any good news?

Guylène Thériault

Yes, I think that overall the report highlights good news. In 2017, the first report kind of highlighted the fact that there was overuse of tests and treatments. It was clear, we had data. And this is the first report where we can see a follow-up. Did it change the situation? The report actually looks at 12 tests and treatments, and we saw a decrease in 8 out of those 12. I think that’s good news.

What seems to be the most difficult to work on at the moment is imaging, because of the 4 recommendations out of 12 that have not really changed, 3 are related to imaging. For example, brain imaging, CT scans and brain scans following a minor head trauma with no signs of concern. Back imaging… it’s very common for Canadians to have back pain at any age, and as they get a little bit older, a lot of people will strain and have back pain. So imaging for back pain that is not immediately worrisome. We also have lung X-rays for children who visit the emergency room and have symptoms of bronchiolitis asthma which are not worrisome either.

So when I look at the total, 3 of the 4 categories for which there was no improvement are related to imaging. Maybe there’s an underlying cause to think about. But what is really interesting, for me, is that we’re seeing a decrease in the use of antibiotics, as well as in the use of blood transfusions. And this is multifactorial. The decrease comes from many things, but what is interesting is that at Choosing Wisely Canada, we have two major campaigns. One aimed at the appropriate use of antibiotics and one aimed at reducing the inappropriate use of blood products.

So we are pleased to see that at least we are moving in the right direction. We’re not saying that this decrease can all be attributed to the campaigns, but nevertheless, we are moving in the right direction.

Alya Niang

We can say that although there is still work to do, there has been good progress.

Guylène Thériault

Yes, I would say that there is progress, but as you say, there is still work to do. Because we can never get to zero. We can never be perfect because there are always cases where imaging or treatment will be indicated. But still, we still see high percentages of overuse. We estimated 35% in 2017, which is still huge. You will understand, and I’m sure my colleague will agree that this disrupts or diminishes the ability to access care. So the busier we are doing things that don’t actually help our patients, the less time we have to do things that help our patients.

So any decrease, as you say, is in fact good news.

Alya Niang

Dr. Wittmer, let’s hear from you. As a primary care family physician, you probably see cases of back pain all the time. Do patients ask for these tests? What happens when you say no, it’s not necessary? Do you ever give in? How difficult is it to reverse this problem?

René Wittmer

There are several parts to your question. First, do patients demand tests when they have back pain? I would say that it’s not uncommon for patients to come in for a consultation wanting a test, wanting to have an X-ray. But what this question or this request shows is that there is an underlying concern. Someone who comes in with back pain and asks for an X-ray is potentially worried about a serious illness, or potentially worried about something because they know someone close to them who has had a serious illness.

I would say, beyond demanding a test, patients often come in wanting to be reassured or at least to understand what is happening to them. They want to know how long it’s going to last and if there’s anything they can do to speed up recovery, for example. I would say that if that’s the reason for the initial consultation, or if we feel that our patients just want to be tested, there are very few cases that don’t get resolved after a clinical assessment, a good questionnaire, a good physical exam. It is very rare that we need to perform these tests. And it’s very rare that patients don’t accept our recommendation to defer the imaging test. Because we’re talking about acute back pain here, so the first few days or weeks when you don’t have any alarm signals.

However, sometimes a back pain that becomes chronic or a back pain that has certain characteristics will require an imaging test. Patients are much more likely to accept our recommendation that at this point we don’t think it’s necessary, but to come back and see us if the back pain doesn’t get better with the advice we give them, and that we can do an examination later on, if it’s still necessary.

I would say, it’s rare that you need to say “no” at all. In fact, we need to say no unless this happens and one offers a recommendation that is other than imaging. Most of the time when we say no, I would say it’s a lot how it’s brought in. Do we manage to explain to our patients why it is not necessary or even better, to explore why they think it is necessary? And to reassure them that, despite their concern, we do not think they need it for XYZ reasons.

Do we ever give in and ask for an X-ray when we don’t have to? I think everyone has done a test and thought, well, we’re in a grey area or the patient seems to really want it and we’ve discussed the pros and cons and we’ve ordered a test and in retrospect maybe it wasn’t really necessary. The point is not to throw stones at people who have already done it. I think we can all remember a time when we weren’t perfect. It’s an interesting question, because we know that there are a lot of factors that influence why clinicians prescribe tests or treatments when they know it’s not entirely useful. I’m using antibiotics as an example, but we know that the propensity to prescribe certain tests or treatments is influenced by the level of fatigue of clinicians, by the time of day or by the type of shift in the emergency room. We have to remember that clinicians are only human and that we are sensitive to our own personal biases, and also our level of fatigue.

Alya Niang

Indeed, I also think that it is very important to have this relationship of trust between the doctor and their patient in order not to create any doubt.

René Wittmer

Yes, trust and relationship, I would say. We are privileged as family doctors because we get to develop bonds with our patients. They know us and we know them. They trust our professional judgment. So it may be easier to explain that when we know the patient well and when they know they can come back if things don’t get better, as opposed to an emergency care setting where sometimes you don’t have that connection with the professionals. But it really illustrates to us how the ability to develop a bond quickly, and then create a bond of trust between professionals and their patients, is really a key element in reducing the overuse of certain tests and treatments.

Alya Niang

Indeed it is. Dr. Thériault, there is a huge international concern about the overuse of antibiotics, as inappropriate use can lead to antibiotic-resistant bacteria and untreatable infections. When you started measuring this in 2014, how bad were things? What does the latest data show? Is this acceptable? How serious is the problem? How do you deal with it today?

Guylène Thériault

In fact, I would point out that Choosing Wisely Canada does not perform measurements. It is CIHI that allows us to have measures to know if, as I said earlier, we are going in the right direction with our actions. Antibiotic resistance is indeed a serious problem, as you mentioned it. I was still surprised to learn that 5,400 people die each year in Canada from causes that are attributable to antimicrobial resistance. That’s a lot of people. And if we don’t do something, if we don’t change the way we use antibiotics, it’s just going to increase and we’re probably going to double the number of deaths there within a few decades.

Choosing Wisely Canada launched a campaign called “Using Antibiotics Wisely.” It’s already been several years, I think we started the campaign in 2018 or 2019. We have a lot of tools, both for patients and for clinicians, to help us remember basic things, yes, but it’s worth it sometimes to remember the basics, to know when I should treat a sore throat with antibiotics. When should I treat an ear infection?

Through a partnership with RxFiles, which is also a Canadian organization, we have developed a viral prescription pad. So really, it’s like I’m giving you a prescription with all the necessary information, that explains what I think you have and how to get relief, but there’s no antibiotic on there. And we believe that this can have an impact, at least in helping the clinician feel that they are useful to the patients. Also, to meet the needs of patients who want to know what they have, like the back pain that Dr. Wittmer was talking about earlier. They want to know what’s wrong and how they can relieve their symptoms.

Because again, saying that patients are going to come in and then demand antibiotics, that’s not really the reality, at least as described in the studies. They really want to know what they have. They are concerned, and they want a plan to address their symptoms.

So this campaign is still relevant. It was updated during COVID. We changed our tools a little bit. Now, we believe COVID is starting to slow down and we are still updating these tools. A viral prescription pad for children has also been added a few months ago on the website.

Alya Niang

Perfect. Thank you, Dr. Thériault. Dr. Wittmer, I know this is an issue with families, especially with children who ask for antibiotics. You may be in tune with Choosing Wisely, but what about your colleagues?

René Wittmer

It’s interesting because I think it perpetuates the myth that patients or parents of children or their families want antibiotics. To build on what Dr. Thériault was saying earlier, I think people who come to us ultimately want to know what they have and especially if they need antibiotics. I think that in most cases, when we explain to patients and their families that they don’t need a prescription because their infection is viral and can’t be treated with antibiotics, most are quite willing to accept that we won’t prescribe antibiotics and that they need to contact us if symptoms don’t improve in a certain number of days. It’s critical, I think, to have realistic expectations about the duration of symptoms.

I take the example of cough, the average duration of a viral cough is generally more than 2 weeks and people are surprised to hear that. But it’s normal for a child to cough for a long time even when it is a viral infection. Unless there are other characteristics that make us believe that there is a bacterial infection, the treatment consists of observation, getting rest and waiting for things to pass in most cases.

Unfortunately, our perception often perpetuates the myth that this is what patients expect. And what’s interesting is that the literature shows us that prescribing antibiotics does not necessarily correlate with patients asking us for them, but with our perception as clinicians of how much our patients or their families want them. So again, it’s all about communication and looking at what our patients’ expectations are. I routinely ask my patients if they expected to be discharged with a prescription for antibiotics. Most people will say: “Only if you think it’s necessary.” The answer is not always that they want the antibiotics.

To circle back to your question, what about my colleagues? I think we’re discussing the subject. We are people trying to choose wisely, trying to use antibiotics wisely, and I feel like the trends are improving. I think there have been a lot of efforts to raise awareness among professionals and the public about the issues and the harmful effects of antibiotics, particularly unnecessary antibiotics.

So intuitively, without any numbers to back it up, I would say that in the field, I see that it’s more readily accepted by families and by patients, and it’s also a trend that I see with my colleagues who are prescribing fewer antibiotics than they used to. I work in a university setting and when I look at my residents and trainees, I see the change over the years. We are training them better at being able to explain to parents or children when they need antibiotics or not. I believe that we are on the right track for the future, that we will have generations of clinicians who are increasingly aware of this problem.

Guylène Thériault

If I could just add something because I think that what you’re saying is also being seen in the report as well, which is a decrease in antibiotic use in Canada. So it’s multifactorial, probably. What we see in the field seems to become reality when we take a slightly more objective measure like the one in the report.

Alya Niang

I must admit that as a parent, this report allows me to understand a lot of things better. For example, I went to see the doctor because my daughter was coughing a lot. He told me there was nothing he could give her and that it would go away on its own. It was hard for me because I really wanted something to help her and to stop the cough. But with time, it did pass.

So again, it comes down to trust.

René Wittmer

And it really says a lot about the importance of good communication, so that parents don’t come out of the office with the idea that their child has nothing. Their child has a cough, their child has something. The doctor explains that their child is in fact sick, but that their condition can’t be helped by antibiotics. And that’s not the same thing.

Alya Niang

Yes, and you have to believe in it, have trust.

René Wittmer

You have to believe, because when a parent is in front of you, and they haven’t slept for 3 nights because their child has a fever, I think it takes empathy to say to yourself they had a difficult day, and try to explain things clearly.

Alya Niang

Another area is preoperative testing. I was surprised to learn that some patients undergo chest X-rays and cardiac stress tests for low-risk procedures such as endoscopy or eye surgery. Are these tests really necessary? Why do them in the first place, Dr. Wittmer?

René Wittmer

You’re putting your finger on a problem. We know that preoperative exams are frequently overused, in the sense that they are used in contexts where they don’t have any benefits or impact on the course of action. An example of this is low-risk surgery, so eye surgery, endoscopies… In most cases, we don’t need to do preoperative testing because it won’t change the course of action. It’s different if you have a patient who is going into cardiac surgery, which has the highest risk of complications, and in that case, we have to ask ourselves if certain tests are necessary.

Now, we know that they are useless in the case of minor surgery. If I may say so, why do we continue to do these tests when we know that they are useless? Well, one of the things we know is that clinicians have habits and some become bad habits over time. Sometimes, it’s hard to break habits when we have always done things a certain way, when we have always asked for tests for all surgeries. These habits tend to stay with us. So we tend to keep doing the same thing. When clinicians are questioned about why they do unnecessary procedures, tests or treatments, most argue that they are running out of time and that simply continuing the same way they have always done is a way to save time.

Ultimately, we probably don’t save that much time because it takes time to write consultation requests, to follow up on analyses, and to manage unexpected incidental findings that may arise from these tests. So in the end, we’re probably not saving that much time and also causing delays for those patients who actually need a preoperative exam that could impact the course of action.

So there are many reasons why this is still done and sometimes it’s just a lack of information. The fact is people don’t know that for low-risk surgery, it’s not necessary to do these preoperative investigations. Doctors and professionals, in general, I think, are also very fearful of having complaints or having complications. I don’t think any clinician gets up in the morning thinking they’re going to do unnecessary testing on purpose. People don’t do it consciously, they do it in a benevolent way, with the idea of doing the best for their patients. And this idea that doing more is better is very much ingrained in our minds, even though we know that this is not always true.

And it’s true for our patients too, sometimes we have this idea that there is no risk in doing an exam, when we know that these exams can carry risks when they are not used in the right context.

Alya Niang

Indeed. What did the Choosing Wisely campaign recommend? And what happened between the 2 reports?

René Wittmer

The Choosing Wisely campaign has produced toolkits on a variety of topics, such as the use of urinary catheters in hospitals, and there is a toolkit on the judicious use of preoperative assessment. This toolkit is designed to help clinicians better target the context in which this type of intervention or preoperative examination is needed. We have charts that can help inform people and help them choose the context where it is necessary. But above all, they guide clinicians and help them go from point A to point B by making better use of these tests.

So, who do you get around the table to start a quality improvement project? Who are the key people being questioned? What indicators will we measure before and after the intervention, and what are some example of interventions that can be done? So it really is an instructional manual for better utilizing resources in terms of preoperative examinations in their setting. And toolkits similar to this one on a multitude of other topics are available on Choosing Wisely Canada’s website.

As for your other question, since this report is brand new, I would ask Dr. Thériault if there are any data differences between the 2 reports.

Guylène Thériault

So, yes, this is one of the 8 practices for which we saw a decrease. But still, 1 in 5 patients who had low-risk surgery underwent preoperative tests. There is definitely room for improvement.

Alya Niang

A very hot topic is the medications and sedatives commonly prescribed to seniors to combat insomnia and anxiety, which may increase the risk of falls, hip fractures, hospitalization and death. What was the situation in Canada when you started tracking this practice, Dr. Thériault? What does the latest data show?

Guylène Thériault

We know from this new report that there is a downward trend. So that’s really encouraging because one of the recommendations is aimed at opiates like benzodiazepines and antipsychotics, molecules for which we probably need to rethink our practices. Interestingly, we can see a decrease in this area. It’s similar to preoperative tests, but in this case, 1 out of 12 patients still use these molecules. And when we look at it across Canada, there are probably still too many people who use these molecules without any benefits.

I think it’s interesting that these concepts are increasingly being discussed in the training of new physicians. If we can manage not to prescribe them in the first place, it would help a lot. Because deprescribing medications is a wise choice and you always have to evaluate things when you have a list of medications in front of you. It can be more complex for people who have been taking it for a very long time versus if you hadn’t prescribed it in the first place and instead given alternatives to relieve the symptoms.

Alya Niang

Indeed. That brings me to my next question. Dr. Wittmer, did you find that you had to deprescribe, meaning to take patients off these drugs?

René Wittmer

Absolutely. I think we need to review the data regarding the adverse effects of these medications, and I believe that it is our duty as physicians to inform our patients of these risks and to make an intervention plan. Either by reducing the dose or even entirely stopping the medication, if possible and if patients cooperate. And I would add that when we explain to patients that their medication has more risks than benefits, the majority of them are open to starting this discussion and to begin an intervention plan to eventually stop them.

Again, it comes down to the art of communication and explaining things thoroughly, putting them in context. There are days when our patient comes in with various symptoms, so it may not be the right time to talk about prescriptions. As physicians, we need to choose the right time to intervene. Represcribing medications and refills are a key opportunity that we must seize to reduce the medication burden among seniors.

Guylène Thériault

I would like to add that Dr. Wittmer is working with another Dr. Thériault on developing a tool to help physicians and front-line workers have these discussions with their patients. This tool will be available on Choosing Wisely’s Quebec website in a few months.

Alya Niang

Perfect, thanks for the information. Blood transfusions in hospitalized patients. How have they been overused and what is the risk, Dr. Thériault?

Guylène Thériault

Actually, that’s really interesting because it’s one of the big campaigns, much like the antibiotic campaign I talked about earlier. To build on what Dr. Wittmer was saying earlier, physicians or front-line workers often have some things they do automatically. We’ve learned to do things a certain way, and then we have so much to do that sometimes we keep repeating what we’ve always done.

For example, when a patient has anemia, doctors often tend to prescribe 2 units, 2 transfusions of blood right from the start. So that’s 1 issue which is addressed in the tools we’ve developed. It asks why 2 units... why not start with 1 and then re-evaluate? Same goes for the target, which is the threshold when we think about transfusing a patient. People who have been practising medicine for a long time saw targets slowly decreasing over time without any complications for the patients.

So a doctor and a working group  came together to work on tools to help hospitals develop a plan to reduce blood transfusions. The hospital can use it as a sort of guide to measure and document their practices and see if they were meeting those targets. So there would be no transfusion if you were not below a certain threshold, for example. Also, not 2 units at once, but 1 at a time. So hospitals saw how far they were from the targets. They changed the way they were doing things using the tools that were provided through the campaign. And they could submit data on a regular basis until they hit the targets, to receive a logo saying “Using Blood Wisely Hospital.”

So it was very popular, and it’s still going strong, with hospitals continuing to sign up. Some hospitals in Quebec have now received their logo and we are very proud of them. The same process has already started in labs, and we are going to have a certification for the hospitals called Using Labs Wisely.

I think it was a very encouraging and motivating way for the community to change their practices regarding blood transfusions.

Alya Niang

With respect to the pandemic, is this a difficult time to sell the idea of choosing tests and treatments wisely?

Guylène Thériault

At the beginning of the pandemic, I don’t think it was a good time. We had a lot of other things going on, we had to learn to live with this new disease. Setting up our clinics, dealing with our patients, conducting virtual consultations…

It was a time of crisis and disruption and we had to adapt. But what the pandemic did, over time, is it made us realize how fragile our health care system was and how it was pushing the limit of what it could give to the population. So I think that the message sheds new light on this problem. Because if we could really cut down on unnecessary testing and treatment, we’d have more access for patients who really need it.

For me, there’s nothing that saddens me more than having a cancer patient who really needs imaging because she needs chemotherapy, but I have trouble getting it. And I know for sure that there are many patients with back pain that are having imaging done. It’s not the patient’s fault, but the system that is to blame for not helping us provide the right treatments and the right tests, always pushing us to do more.

If there’s anything that the pandemic has emphasized, it’s the fragility of our system, not that we didn’t know it before, but I think it’s even clearer now. I hope that this message will resonate even more and make us think about using our resources more wisely so that we can give quality care to people who really need it.

Alya Niang

The recommendations of the Choosing Wisely campaign became very important at one point. Blood tests are a fundamental diagnostic tool for hospital clinicians, and repetitive ordering of blood tests in patients with no clinical indication and no need for them represents low-value care that can be avoided up to 60% of the time. And there was a shortage of blood tubes. How did you help, Dr. Thériault?

Guylène Thériault

In fact, when Choosing Wisely understood that there was a critical shortage. We, meaning the central team in Toronto, connected with the laboratory doctors to see how we could support them, how we could make sure the message regarding this problem was shared.

A lot of literature was written. We also helped develop recommendations that were then shared through Choosing Wisely’s website in order to make people think and say… well, this test probably doesn’t need to be repeated if it has already been done, or this test does not need to be repeated so often, etc., in order to reduce the use of blood tubes. Because the sampling tubes were in short supply.

If there is an issue like that, we are there to help people share the message that doing less is in fact doing better.

René Wittmer

On top of the tube shortage, there is also the fact that we simply don’t have the human resource and the time it takes to collect the tests and analyze them. It generates a lot of volume in the health care system. Eliminating these unnecessary tests would probably improve the timeliness of access to blood sampling in some settings. So there is the whole issue of human resources, we know that we lack nurses, we lack professionals.

Therefore, using them wisely allows us to make good use of the human resources we have in the health network, which are precious and lacking.

Alya Niang

Dr. Thériault, could the Choosing Wisely protocols and guidelines help ease the pressure on hospital and clinic staff during the pandemic?

Guylène Thériault

Overall, I think so. I’m not sure we have protocols, but we have tools to facilitate changes in practice, whether in clinics or hospitals. So yes, I think it’s a quality improvement approach to the care we provide. Except that before, quality improvement was about adding something. Now, our tools make people realize that to improve the quality of what we do, we may actually have to cut out some tests and treatments.

So yes, it’s very much in the spirit of wanting to lighten the workload. There will always be a lot of work, but if we work at 100% and a large percentage of this is useful to our population, well I think we have already made progress.

Alya Niang

Do you think it could also contribute to the recovery of the system after the pandemic?

Guylène Thériault

I think that the post-pandemic recovery is a big task, but the tools and the momentum of the campaign can help. Is this the ultimate solution? I don’t think so. It’s part of a panel of solutions that will have to be put in place for our system to survive, actually. But using our tests and our treatments wisely can only encourage this reflection and this reconstruction within our health system.

René Wittmer

Ultimately, it can’t hurt, as Dr. Thériault said. The idea behind using resources wisely is not just to ensure the survival of the health care system, it goes beyond the positive impacts that it has on our system. At the core, we need to remember that it’s about improving the health of our patients.

No one thinks we should do less testing with the idea of rationing, or with the idea that we should do less for our system. The idea is that it helps to improve the health of our patients and to reduce complications and unnecessary tests. We’re really talking about care that is unnecessary, that can’t help our patients. To reassure people who are listening to us, who are thinking: we are cutting because our system is in distress. Actually, no, we’re doing this to improve people’s health and ultimately it will also help our system.

Alya Niang

Dr. Wittmer, what type of questions should patients ask?

René Wittmer

Dr. Thériault mentioned earlier that Choosing Wisely developed a list of questions that patients can ask their health care professionals about whether they really need a test. There are 4 very simple questions that I would encourage patients to ask their doctor because ultimately the Choosing Wisely campaign makes recommendations on things that we should be questioning that we should be having conversations about whether or not they are useful.

And while we agree that recommendations are made so that in the majority of cases, a particular test or treatment is not recommended, there are situations where it may be appropriate for a patient. That’s really the whole idea that we need to open up conversations and discuss the relevance.

It’s these 4 questions that our patients can ask if they really want to make sure that something is relevant for them: 1, do I really need this test, this treatment or this intervention? 2, are there any side effects? 3, are there any options that would be simpler or safer? And 4, what happens if I do nothing? Is it okay to say we’ll talk in a few weeks, days, months to see how your symptoms have changed and decide then if we’re going to test? Observation is a powerful tool available to us as family physicians. We can afford to say that we will reassess some symptoms. And unless there are certain alarm criteria, in many cases, it’s appropriate to say that we’ll talk about it at a later date to see if the symptoms persist and to meet again if they get worse.

So sometimes doing nothing is the best thing and giving yourself some time.

Alya Niang

Thank you very much, Dr. Thériault, and thank you very much, Dr. Wittmer. It was a really productive exchange for this podcast.

Thank you again.

Low-value medical tests and treatments consume valuable hospital resources and may not actually benefit the patient. There are ways to limit overconsumption, and the pandemic may be a good time to take a close look at what is necessary and what is not.

Thank you for joining our discussion. Our executive producer is Jonathan Kuehlein and special thanks to Aila Goyette and Avis Favaro, the host of the CIHI podcast in English.

If you would like to read the new Choosing Wisely report produced with the Canadian Institute for Health Information, please visit www.cihi.ca. Don’t forget to subscribe to the Health Information Podcast and listen to it on the platform of your choice. I’m your host Alya Niang, see you soon.