A new video for clinicians, highlighting the importance of Choosing Wisely,has been released by the Health Quality & Safety Commission.
Choosing Wisely is an international campaign that began in the United States of America in 2012 and rapidly expanded internationally. Its aim is for patients and whānau to receive the highest quality care by reducing unnecessary tests, treatments and procedures, and by promoting shared decision-making between health professionals, patients and whānau.
Choosing Wisely Aotearoa New Zealand was launched in 2016 by the Council of Medical Colleges and many medical colleges and district health boards have been involved.
The video includes stories from health care consumers Falyn Cranston and Kaushiki Roy, along with advice from Dr John Bonning, president of the Australasian College for Emergency Medicine, chair of the Council of Medical Colleges and an emergency physician at Waikato Hospital. It is presented by Professor David Tipene-Leach, kaihautū/chairperson of Te ORA, general practitioner and public health physician.
Falyn’s four-year-old son Fergus has a severe congenital heart defect called hypoplastic left heart syndrome and a condition impacting his airway. She talks about the difference positive communication makes when Fergus is having treatment.
‘Having someone who communicates clearly, shows compassion and is kind makes a really big difference. When Fergus has a procedure coming up, we want to be sure that there’s not an alternative course of action that could have less of an impact on him in both the short and the long-term.
‘We’ve been in a situation before with his respiratory condition where there was a potential fix for the issue but as we talked through it with his team, we decided together that it was in his best interest to see how things went rather than intervening now. Sometimes we don't have much of a choice about a particular intervention but, given the option, it's nice to be able to think about the impact it will have on him.’
Kaushiki Roy has Cushing’s disease. Cushing’s is a rare disease causing excess production of the stress hormone cortisol, which affects multiple systems. She says good communication and working collaboratively with her physicians is important to her.
‘With a complex condition like Cushing’s disease, there’s no silver bullet. I’ve had to make decisions all along about what tests, treatments, surgeries and medication I receive, and I’ve had to weigh up the potential benefits and risks of harm. It really impacts my life in terms of how I live, what support I’ll need, my future, my goals and my dreams. Good communication with my clinicians makes a world of difference.’
Dr Bonning is passionate about the need for clinicians to understand the risks of over-diagnosis and over-treatment.
‘There are questions that every patient needs to understand, and every clinician needs to encourage. Benefits are not guaranteed from any test, treatment or procedure so the ‘BRAN’ questions that should arise every time are: What are the potential benefits? What are the risks? What are the alternatives? What will happen if I do nothing? Clinicians need to help every patient or whānau ask these questions before any intervention, be it a lab test, a CAT scan, a procedure or a course of antibiotics.’