organized curiosity

Improving health care through research

Is More Always Better in Health Care?

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Nearly 25 years ago, my family and I moved to Nova Scotia from Ontario. I had worked for 10 years at the Children’s Hospital of Eastern Ontario in Ottawa as a clinician and as a scientist.  I came to Dalhousie University to start the Clinical Psychology PhD program.

I have observed health care over this time and a few issues have dominated the discussion. Timely access to care is the issue we all care about.  Access to emergency, mental health, diagnostic imaging, and acute care beds are the most common concerns. Most of the time there are no complaints about the quality of care.

The proposed solution is usually more health care. Sometimes the solution is more long-term beds to free up acute beds, sometimes it is more surgical time, more nurses, or more of some speciality medical equipment or test.  Most of the time these solutions are short-sighted.

‘More’ does not always mean ‘better’.   Many doctors in Nova Scotia already understand this and are looking for ‘smarter’ health care solutions rather than just ‘more’ health care.  One recently launched idea by the Canadian Medical Association is Choosing Wisely, a research-based campaign to get rid of unnecessary medical care.

Choosing Wisely identifies care that is not necessary.  For example, most of the time x-rays, MRIs or CT scans do not offer a lot of help for resolving back pain. People don’t get better any faster when they receive these tests. And the tests have two types of risks. The first risk is the radiation you are exposed to. The second risk is that many of these unnecessary tests often find quirky things that don’t mean ‘disease’, but have to be followed up by more tests that bring more risk. Unless there are other reasons to validate the need for the test, this circle will continue.  Unnecessary tests can also cause unnecessary angst and worry for patients and families.

We all have quirky things in our bodies, that don’t mean anything. These quirky things can be abnormal values on a blood test, or small abnormalities in our bones. After all, each of us has a body that is not average – we are all unique.

Each and every test also has a cost: a cost to the patient, a cost to other patients and a cost to the system. The cost to the patient is more radiation or pain, extra worry, and even dollars from time off work or travel to the hospital. The cost to other patients is those that need the test can’t get it if someone is taking their spot in line. The cost to the system is the additional dollars spent on more equipment and more staff.

That doesn’t mean that imaging for back pain is always bad. The website does describe “red flags” where imaging should be considered.

In the USA where Choosing Wisely began, over 55 medical specialist societies have joined and typically designated five different things for each medical specialty that doctors and patients should question.

Choosing Wisely uses research evidence to help you and your doctor, together, make smarter decisions about your health care.

I am disappointed that no one appears to have done research to see if the Choosing Wisely campaign works to reduce unnecessary care. Does it work?  Will it work in Nova Scotia?

I encourage you to look at the Choosing Wisely list. It may surprise you.  It just started in Nova Scotia and more things are going to be added. If everyone chooses a little more wisely, we can make a difference.

~ Dr. Patrick McGrath


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