Choosing Wisely is a new campaign for New Zealand that encourages health professionals to talk to patients about unnecessary tests, treatments and procedures. It will launch on Wednesday 7 December. It is health professional-led and is about providing the best quality of care for the patient.
The campaign is being run by the Council of Medical Colleges, in partnership with the Health Quality & Safety Commission and Consumer New Zealand, and with support from many health sector groups. It has funding from the Commission and the Ministry of Health.
Choosing Wisely is centred on helping patients make good choices and focuses on areas where evidence shows that a test, treatment or procedure provides little or no benefit to a patient and could even cause harm. These are not grey areas where evidence is debatable. Health professionals will be encouraged to discuss the risks and benefits of these tests with patients, so patients can make an informed choice.
Choosing Wisely encourages patients to ask their health professionals these four questions:
- Do I really need to have this test treatment or procedure?
- What are the risks?
- Are there simpler, safer options?
- What happens if I do nothing?
Council of Medical Colleges chair Dr Derek Sherwood says there are a large number of medical tests, treatments and procedures available, but that doesn’t always mean we should use them.
“For example, not only do X-rays and CT scans expose patients to potentially cancer-causing radiation, but many studies have shown scans frequently identify things that require further investigation but often turn out to be nothing. This means patients can undergo stressful and potentially risky follow-up tests and treatments for no reason.
“Other examples of tests and interventions to consider carefully before use are imaging for patients with non-specific acute lower back pain and avoiding prescribing antibiotics for upper respiratory tract infection.”
He says there is evidence some inappropriate clinical interventions and treatments are being used in Australia and New Zealand.
“The common factors across countries that contribute to health professionals ordering unnecessary services include patient expectation, lack of consultation time, overall uncertainty and fear of missing a diagnosis or malpractice concerns, reimbursement incentives, the way health professionals are taught and avoiding the challenge of telling patient they do not need specific tests. The result can be care for patients that adds little or no value and may cause harm.”
Seventeen medical colleges and specialty societies in New Zealand have already developed recommendations about which tests, treatments and procedures should be avoided. These have been developed with health professional input and consultation after review of the evidence. Each recommendation is supported by evidence and resources to assist health professionals.
Dr Sherwood encourages health professionals to review the lists of tests, treatments or procedures to be questioned and act accordingly.
“It is important to talk with patients about the care that is being recommended and use shared decision making. This includes listening to the patient about their experience of illness, their social circumstances, attitude to risk, and their goals, values, preferences and support needs.”
Patient education and engagement is an important part of Choosing Wisely, and the Council of Medical Colleges is working with Consumer New Zealand and other organisations to promote campaign messages and develop resources for consumers/patients.
The campaign will communicate these messages in a number of ways, including via a website, posters and other printed material, online advertising and in social media. To find out more, go to www.choosingwisely.co.nz from 7 December.