The Quebec College of Family Physicians (CQMF) is trying to fight against the overuse of tests and treatments as well as the issues of overdiagnosis. He launched the “Montreal Declaration on Meaningful Health Care” on Thursday so that health care partners can tackle these problems.
In Canada, 30% of tests, treatments and procedures are considered unnecessary, according to data from the Canadian Institute for Health Information. In other words, almost one in three actions performed by health professionals is useless for the patient.
According to Dr. René Wittmer, president of the steering committee of the Choosing with Care Quebec campaign, led by the CQMF, this is 30% more places that could be freed up in the health network. “It’s still considerable,” he comments.
Dr. Wittmer explains that overuse of tests or treatments causes harm to patients. For example, taking an unnecessary radiology exam exposes the patient to radiation. It can also lead to “chance findings” that are not dangerous for the patient, but may worry them. This can even harm one’s ability to take out insurance later, points out the family doctor. “There may be harm to patients,” he says.
Another situation that is still too common, according to him, concerns the prescription of antibiotics to patients with a viral infection. “We know that giving antibiotics in these contexts is useless, it does not help the patients, it even harms them. It gives them diarrhea or other side effects. »
These situations can also contribute to overloading the health system. A prescribed treatment can have side effects that lead the patient to seek medical advice and could even lead them to the emergency room in more severe cases.
Dr. Wittmer doesn’t blame family doctors for being cautious and he’s convinced they have good intentions. “When doctors prescribe a test or treatment, it is because they have the impression that it could help the patient,” he maintains. According to him, they may not be well informed and unaware that tests may prove unnecessary.
The “just in case” test
According to Dr. Wittmer, both patients and professionals mistakenly believe that doing more is probably better for their health. Although tests are often important in making a diagnosis, they are not always essential, he says.
“We might wrongly believe that it is really essential to make a good diagnosis, whereas in many situations, a diagnosis that we call clinical – therefore based on what patients tell us and what we have observed in examining them — is enough to make very good diagnoses,” he said.
In these cases, the doctor will often say: “while we’re at it” or “just in case”. It is precisely in these situations that tests are useless and even potentially harmful for patients, argues Dr Wittmer.
He urges health professionals to ask themselves whether the test is absolutely necessary and what they will do once the result is obtained. Will the result influence the patient’s treatment?
Overdiagnosis
Dr. Wittmer describes the phenomenon of overdiagnosis as abnormalities that are found in the patient, but would never have been detected if testing had not been done. These abnormalities would never have manifested and would not have made the patient sick.
It’s counterintuitive, he admits. We may believe that early detection is better, and this is true in certain cases. For example, colon cancer screening is not associated with overdiagnosis and the benefits of this test are well demonstrated, he says.
This is not the case for prostate cancer where there is a lot of overdiagnosis. “If we screen for prostate cancer with a blood test, it has very little impact on the number of men who will die from prostate cancer. If I screen 1000 men over ten years, there is approximately 1 less in 1000 who will die thanks to the screening,” maintains Dr Wittmer.
Several health groups such as the National Institute of Excellence in Health and Social Services (INESSS) do not recommend offering prostate cancer screening systematically, but rather for men at higher risk.
In this specific case, overdiagnosis means that we treat men who would not have been impacted by prostate cancer. “We remove their prostate with all the consequences that this has, all the worry that it can generate to be told that we have cancer when in the end it does not help them,” explains Dr. Wittmer.
During a visit to the doctor, he invites patients to discuss with the latter the risks associated with treatment.
He lists four questions that can guide the patient in his thinking. Do I really need this treatment, test or procedure? Are there any negative sides? Are there simpler and safer options? What happens if I don’t do anything?
Medical personnel sometimes request a test deemed unnecessary for fear of reproach from a professional order. “So it is important that professional orders take part in the discussion and show that it is important to prescribe tests in the right context for patients,” emphasizes Dr. Wittmer.
The objective of the CQMF declaration is to invite the signatories of the declaration (College of Physicians, Order of Pharmacists of Quebec, Order of Nurses of Quebec, Federation of Specialist Physicians of Quebec, etc.) to pose small actions to ensure that we provide less and less unnecessary care.
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