Choosing Wisely NL (CWNL) helps patients and their healthcare providers start the conversation about being healthcareful and choosing appropriate tests, prescriptions, and other therapies. Every few weeks, we focus on a different therapy or condition that YOU can talk to your provider about, whether that’s your doctor, your nurse practitioner or other clinician.

Approximately 2500 tests for Peripheral Artery Disease (PAD) are performed at St. Clare’s Vascular Lab every year; about half of these are unnecessary. If you’re not sure if you’ve got PAD, let Dr. Greg Browne teach you the signs to watch for so you can Choose Wisely and be healthcareful about testing!

Four questions to ask your healthcare provider:

  1. Do I really need this test, treatment or procedure?
  2. What are the downsides?
  3. Are there simpler, safer options?
  4. What happens if I do nothing?
FAQs
How are unnecessary tests harmful to patients?

Medical tests such as blood tests or X-Rays can be helpful for health care professionals trying to distinguish among potential diagnoses. A test that is not relevant for the particular diagnostic question is more likely to cause confusion. Test results can be abnormal due to chance alone and in particular, minor abnormalities in blood test results or findings on X-Rays that are common anyway and not connected with patient problems can lead to a false conclusion that a problem exists when in fact it does not. Often times when faced with an abnormal test result, the health care professional feels obliged to order further testing or initiate treatments that may be inappropriate. Some tests are merely an inconvenience, such as having a blood sample collected while others pose more risk, such as radiation exposure.

How will Choosing Wisely improve health care in Newfoundland and Labrador?

Choosing Wisely is a physician initiated program that is now international in scope. Various professional bodies were asked to identify tests and procedures that may be of low value in that they rarely lead to an improvement in health outcome or are potentially harmful when applied to patient groups that do not have any reason to be considered for these tests or procedures. Choosing Wisely Canada has catalogued these low value health care interventions. Choosing Wisely NL will examine use of various tests and procedures in the province and seek to determine if there are instances of unnecessary use that might be associated with harm. Choosing Wisely NL will then seek to work with health care professionals and the public to improve the use of these tests and procedures such that they are only used for patients or groups that may benefit from them. The hope is that this will lead to improved health care and outcomes in the province.

Will my doctor be familiar with Choosing Wisely NL?

Yes, the Choosing Wisely NL program will be undertaking a campaign to educate physicians within the province about CWNL and how they can participate in it.

Who runs Choosing Wisely NL?

Choosing Wisely NL arose from research work being done at the Faculty of Medicine of Memorial University. The group of researchers engaged patients, the medical association and health care authorities as partners to develop the program. Recommendations to health care professionals and the public about the appropriate use of tests and procedures will be put out by this group.

Is Choosing Wisely NL a strategy to cut provincial health care costs?

Reduction of health care cost is not a specific goal of any Choosing Wisely initiative. The aim is to improve health outcomes through the more appropriate use of health care tests and interventions.

How does Choosing Wisely impact me as a patient?

You may find that your doctor or health care professional mentions Choosing Wisely when recommending a specific course of action to you for your conditions. If so, the doctor or health care professional is following best practice guidelines and is attempting to work with you to make the best recommendations for tests and procedures that will benefit you specifically.

How does Choosing Wisely impact me as a medical professional?

Choosing Wisely NL will seek to educate physicians about the most appropriate use of tests and procedures. It is understood that health care professionals already have a significant body of knowledge about the appropriate use of tests and procedures, but medicine is a rapidly evolving field, and it is clear that not all tests currently ordered are appropriate or necessary. Choosing Wisely NL will seek to work with the physicians to help them make the best possible choices of care for their patients. Choosing Wisely NL is not a monitoring program, and there are no intentions to introduce any sanctions for physicians or other health care professionals who do not utilize specific recommendations arising from Choosing Wisely NL. It is hoped, however, that health care professionals will see the value in the recommendations arising from Choosing Wisely NL and take these recommendations into consideration when working with their patients.

What if my doctor and I disagree on what treatment is necessary and what isn’t?

This type of disagreement could arise in any clinical interaction and is not specifically more likely to occur because of the Choosing Wisely program. In any health care interaction between a health care professional and a patient, it is important that a frank and open discussion occur such that the health care professional has all of the information necessary to make the best possible recommendations and the patient is fully informed such that they can participate in making a decision about what is best for them. It is ethically important for physicians and other health care professionals not to recommend or facilitate access to tests or procedures that may be clearly harmful. There is no requirement, for example, for a surgeon to perform an operation merely because a patient wants it if in the surgeon’s view, the operation would likely to lead to more harm than benefit.

Isn’t getting a test always a good idea because it helps rule out possibilities?

Tests can help to increase or decrease the likelihood of a particular diagnosis being present. In some cases, the diagnosis is already clear and further testing would be unnecessary. In other cases, particular diagnoses may be so unlikely that the use of a test is more likely to yield a false result than a truly helpful result. It has been stated that just like drugs have particular reasons for which they should be used, tests are similar and should only be used in situations where the results may be likely to change the probability of particular diagnoses.