The Canadian Medical Association has put its stamp of approval on a growing movement of doctors tackling unnecessary, possibly even harmful, over-testing and over-treating.
Following a widely supported resolution at the CMA's general council meeting in Calgary on Tuesday, the organization representing Canada's doctors will form a working group to determine practices "for which benefits have generally not been shown to exceed the risks."
The CMA has asked societies of medical specialists to come up with lists of five to 10 tests and procedures that may be used too often or even be risky for patients.
"If we're going to try and improve the efficiency, and reduce errors, in our health-care system, then what we should be doing is only things that we know will be beneficial to patients," said CMA president Dr. Louis Hugo Francescutti.
"The exercise is not to reduce costs; the exercise is to give the patient the best possible care. And what usually ends up happening is that you reduce costs at the end of the day."
It mirrors a U.S. campaign started in 2011, dubbed Choosing Wisely, which now has the support of dozens of medical societies that have identified hundreds of tests and procedures.
Among the common practices called into question south of the border are routine diagnostic imaging for headaches and short-term lower back pain, prescription of antibiotics for sinusitis, annual electrocardiograms (commonly called EKGs) for low-risk, symptom-free patients and annual Pap tests.
Antibiotics aren't effective against viruses — the most common cause of illness — and even bacterial ear and sinus infections frequently clear up on their own, avoiding risks of side effects and superbugs.
While diagnostic imaging can provide helpful information in some cases, it also exposes patients to radiation, which can itself cause cancer, or leads to invasive tests that carry other risks.
"An unnecessary test is often worse than no test because it can lead to even more tests and procedures, some of which are invasive and carry their own risks," said Dr. Scott Wooder, president of the Ontario Medical Association.
And testing opens the doors to false positives, causing anxiety on the part of patients.
"False positives are a kind of harm. It can be harm psychologically, and physically," said Dr. Wendy Levinson, a professor of medicine at the University of Toronto who worked on the Choosing Wisely campaign in the U.S.
Levinson, who chairs Choosing Wisely Canada, said society has built an underlying belief that "more is better."
"But when you talk about not ordering a test . . . Canadians can think this is about rationing," said Levinson. "This is not about cost-cutting. It's about changing the culture and starting to talk about overuse and waste and harm. I don't think patients really appreciate that when they ask for a CT scan or imaging, that's unnecessary X-ray radiation. Or drugs that can cause side effects."
Levinson hopes to launch the Choosing Wisely Canada campaign next spring, with the first lists of potentially overused or harmful tests and procedures in hand.
The Ontario government has already replaced funding for annual checkups with "periodic health visits" and cut money for what it called "unnecessary" X-rays, MRIs or CT scans of the lower back when there are no suspected or known problems such as tumours or osteoporosis.
