11 Québec physicians named honorary members of the CMA

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11 Québec physicians named honorary members of the CMA

This year, 11 QMA members have been distinguished by being named honorary members of the Canadian Medical Association (CMA). Eleven highly regarded physicians who in their own way have all shown professionalism and helped to advance the medical profession in Québec.

This membership is bestowed on those who, at age 65 and having been active Association members for at least 10 years, have been nominated by their provincial/territorial medical association and were unanimously approved by the CMA Board of Directors. The nominees must have put into practice the aims and ideals of our profession.

For 2018, the honorary members are:

  • Dr. André Aubry
  • Dr. Hugues Beauregard
  • Dr. Pierre Beauséjour
  • Dr. Rachel Bujold
  • Dr. Pierre Charron
  • Dr. Patrick Côté
  • Dr. Ghislain Devroede
  • Dr. Yolande Leduc
  • Dr. Jean-Marie Moutquin
  • Dr. Michel-André Péloquin
  • Dr. Vita Senikas

Congratulations to our esteemed colleagues!

To learn more about the CMA awards, write to awards@cma.ca.

Aline D. Khatchikian receives the CMA Award for Young Leaders

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Aline D. Khatchikian receives the CMA Award for Young Leaders

Aline Khatchikian
This year, the Canadian Medical Association (CMA) Board of Directors has recognized the commitment and leadership shown by Aline D. Khatchikian by giving her the Award for Young Leaders in the “student” category. Aline is a 5th year student at the Faculty of Medicine at Université Laval. Over the past few years, she has given numerous training sessions around the world to engage the next generation of medical professionals in health issues, as well as to promote the importance of social responsibility in medical practice. She also succeeded in getting a motion passed to include a mandatory course on organ donation in all Québec medical curriculums and she is currently giving a course on this subject at Université Laval.

The Award for Young Leaders celebrates the efforts of young physician leaders of tomorrow for their efforts today. It is presented every year by the CMA to two students, two residents and two early career physicians who are members and who have demonstrated exemplary dedication, commitment and leadership in one of the following domains: political, clinical, educational, research or community service. Candidates must have exemplified creativity, initiative and commitment to making a difference, been active and effective at the local, provincial/territorial or national level, and acted as a positive role model for peers and colleagues.

Aline D. Khatchikian was a member of the QMA’s Board of Directors in 2017-2018 and has been involved with the QMA Student Committee since 2014. We congratulate Aline for this recognition of her dedication!

Inspiring a future of better health

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Inspiring a future of better health

evenement Winnipeg2On August 20 and 21, 2018, the Canadian Medical Association will host its inaugural Health Summit in Winnipeg. This event complements the usual General Council, also known as the “parliament of physicians”. The General Council will be held on August 22, along with the Annual General Meeting (AGM).

The Health Summit will focus on how innovation and technology can transform health care. Whether they are physicians, scientists, government representatives, care providers, patients, innovators or artists, participants will be invited to talk to acclaimed speakers, including former astronaut Chris Hadfield, and patient partner specialist Judith John, to help answer this question:

How do we prepare ourselves, leverage technological advancements, and take advantage of innovation to deliver better and more accessible care?

Several themes will be explored at the summit:

  • Innovation as a support for providing culturally inclusive and accessible care;
  • Technology for enabling and promoting patient-centred care, and for better serving vulnerable populations;
  • The role of patients and physicians in the gradual adoption of artificial intelligence, robotics and major changes;
  • Humanity, inclusion and reactivity for ensuring a future of better health.

Particularly important this year, the AGM will offer an opportunity to discuss the changes that the CMA wants to make to its governance structure, namely abolishing the General Council.

CMA members will also be able to comment on the new Code of Ethics and Professionalism, the updated version of the CMA’s Code of Ethics, created 150 years ago.

 

To register and for more information about the Summit, click here.

 

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2018-2019 budget

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2018-2019 budget

On March 28, 2018, the Québec government presented a final budget before the elections on October 1, 2018. Below are the highlights related to health care.

With an increase of 4.6% in health care spending, health care costs are increasing this year by $1.5 billion. In total, this amounts to $38.5 billion of the budget that should be earmarked for health care in 2018-2019.

These expenditures “mainly serve to finance health and social services institutions and medical compensation,” explains the Budget Paper.

Spending by health and social services institutions will total $26.5 billion, growing by 5.3%.

Spending by the Régie de l’assurance maladie du Québec (RAMQ) will be $12.9 billion, increasing by 1.5%, which includes an injection of $44 million for medical compensation. The largest share of the increase for compensation, or $352 million, is planned for 2019-2020.

Note that investments of $18.7 billion are also planned for developing the health and social services system.

budget ENG

 

QMA-info has been given a makeover

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Hugo viens low res
It gives me great pleasure today to talk about the new format of your QMA Info. Your newsletter has been given a makeover and will be sent to you every month.

I will continue to discuss the latest hot topics in A Word from the President.

New columns have been added:

  • The QMA in Action will present your association’s position statements and issues.
  • On Parliament Hill will talk about legislation and government decisions that influence our medical practice.
  • Our Members in Action is about you. Every month, we will showcase a member whose work, leadership or remarks are likely to interest you. Would you like to share your experiences? Would you like to present a member physician? The Communications Service is eager to hear from you.

I am very proud of this column because it will give us a chance to get to know one other better. I am always delighted to talk with you. You can write me any time at president@amq.ca. Remember to join our social media communities as well.

And now, it is time to discover your new QMA Info.

Until next time!

Dr. Hugo Viens, B.Sc., M.D., FRCSC 
President of the Québec Medical Association

 

The 2018 Visibility Grant goes to Jeunes en action

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The 2018 Visibility Grant goes to Jeunes en action

Dr. Hugo Viens, president of the QMA, and Alexandre Elhalwi, president of the Student Committee, were pleased to present, last april 20, the 2018 Visibility Grant to Sarah Brunelle, student, and Julie Côté-Leclerc, resident, for their Jeunes en action project.

This grant comes from the special projects fund of the QMA’s Student Committee, set up in 2016, whose mission is to support student initiatives intended to improve the health care system or the well-being of the community. By awarding a grant to this project, the Committee recognizes its exemplary functioning, scope and development potential.

Jeunes en action is a social participation project for youth from disadvantaged backgrounds that aims to educate and raise the awareness of youngsters aged 5 to 12 about different health related aspects, interest them in the health fields and motivate them to continue their studies. These goals will be reached by teaching them healthy lifestyle choices and showing them the diversity of health care programs. Five activities covering physical activity, mental health, dental health, healthy nutrition and the different health care professionals (a fair with kiosks) are organized during the school year in a primary school in a disadvantaged area in the Mauricie region. The success of Jeunes en action is based on interdisciplinarity and health promotion. 

Congratulations to the two recipients!

 

Bourse etudiante

From left to right: Dr. Hugo Viens, Ms. Sarah Brunelle,
Mr. Alexandre Elhalwi. Ms. Julie Côté-Leclerc was
absent at the award ceremony.

QMA Annual Day

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QMA Annual Day

On April 20, the QMA held its Annual Day around the theme of professionalism. On the agenda: the conclusions from the Québec/Canadian tours on professionalism, a presentation on the similarities between professional issues in the medical and legal fields, and an account of the Alberta medical community’s recent experiences.

Dre Isabelle Samson JAMQ4Dr. Isabelle Samson opened by presenting the report from the consultations conducted during the QMA’s Medical Professionalism Tour. Two observations emerged from the many comments made by physicians, the first being that the dual role of caregiver and professional required by the medical profession seems to have been poorly integrated by many physicians.

Second, while most physicians consider the status quo to be untenable, few see themselves as part of the solution or as agents of change. For more information, consult a summary of the report or read the full report here.

Following Dr. Samson’s presentation, Dr. Laurent Marcoux, president of the Canadian Medical Association (CMA), discussed some related initiatives taking place within his organization.

Canada-wide initiatives to foster medical professionalism

According to Dr. Marcoux, professionalism is a fundamental value that “defines who we are and what we do, as well as our relationships with our colleagues and patients.” It is therefore not surprising that professionalism is top of mind in provincial and territorial medical associations across the country.

Dr Laurent Marcoux JAMQ5It is also what prompted the CMA to take steps to better define and promote medical professionalism. Last December, the CMA’s board of directors adopted a Charter of Shared Values that redefines the commitment of physicians to one another. The charter focuses on four key elements: respect, integrity, reciprocity and civility. “We achieve a higher degree of success when we work together and mutually believe in our work, when we make a common commitment and share a set of values, virtues and principles,” explained Dr. Marcoux.

Before the end of the year, the CMA will also present its Code of Ethics and Professionalism, based on its Code of Ethics, which itself is undergoing a major revision to reflect the realities of today’s society. The new code will highlight the virtues that are embodied by the medical profession and put into practice by physicians every day: compassion, honesty, humility, integrity, a moral conscience and trust.

The third element in the CMA’s professionalism platform is an accountability framework that will be unveiled later this year. It will remind physicians of the commitment they made to the medical system.

Dr. Marcoux made use of his visit to Montréal to remind all physicians of the importance of caring for their own health. According to the preliminary results of the CMA’s National Physician Survey:

  • No less than 30% of practising and resident physicians report a high level of burnout;
  • Almost 35% have been diagnosed with depression;
  • The rate of suicidal ideation is close to 19%.

“We must support them in creating an environment where overwork can be avoided, and we also need to develop prevention tools,” explained Dr. Marcoux, with a reminder that the CMA’s very first Physician Health Policy was made public last fall. To conclude, the president called on physicians to commit to improving the network by acting as agents of renewal.

Physicians and lawyers: Facing the same challenges!

Me Savard JAMQ4Associate professor in the Faculty of Law at Université Laval and lead researcher of the Axe Droit et politiques de la santé at the Centre de recherche en gestion des services de santé FSA-ULaval-CHU in Québec City, lawyer Anne-Marie Savard highlighted the similarities between the medical and legal professions.

Like physicians, lawyers are subject to a tacit social contract with the public. However, the model of the lawyer working alone or with partners and being accountable to no one but the client has had its day. In the past few years, we have witnessed the diversification of the legal profession and a bottleneck in the judicial system, which has been marked by a decline in judicial activity. Meanwhile, the number of lawyers has increased.

It should be mentioned that the judicial system no longer meets the needs of justiciables due to the length and cost of proceedings and to dissatisfaction with outcomes, “which has led to a loss of public confidence in judicial institutions and lawyers,” said Savard. Lawyers took note of this fact. Recognizing that justice is a public service, they accepted that they must do their part to apply sound management to legal proceedings, given that the institutions have limited resources.

Collectively, they took the necessary steps to regain the public’s trust. The Bar association lobbied to amend the Code of Civil Procedure in 2014, and a new version came into effect on January 1, 2016. The Code of Professional Conduct of Lawyers was also revised in 2015.

A cultural shift

Savard describes these changes as a cultural shift, within which lawyers had to change their way of working. By adopting the principle of proportionality in the Code of Civil Procedure, “they committed to informing their clients that there are other ways of resolving disputes than litigation (for example, negotiation, mediation and arbitration),” explained the professor. As a result, lawyers are less frequently in court. The new Code of Civil Procedure also incites lawyers to limit proceedings to what is necessary for the purposes of litigation and to work together under the principle of cooperation.

Under the new code of ethics, lawyers are no longer accountable only to their clients; they are also “servants of justice.” They must take into account accessibility to justice, they must facilitate cooperation for the effective administration of justice and to support the authority of the courts, and they must consider the social context within which the law operates. They must also “foster a relationship of trust between the public and the administration of justice.”

In Savard’s view, the context and the means employed to further the legal profession are comparable to those of physicians and the evolution of medical professionalism. As stated in the new Code of Ethics of Physicians, “A physician must collaborate with other physicians to maintain and improve the availability and quality of the medical services to which a clientele or a population must have access.” In other words, a cultural shift toward a more social role is required.

Reinvention is possible

Dr Carl Nohr JAMQ5Dr. Carl Nohr, past president of the Alberta Medical Association (AMA) and board member of the CMA, gave a presentation on the experience of the Alberta medical community, which has recently undergone a profound change in its relationship with the government and the public.

Having obtained an analysis of the breakdown of the social contract that closely resembled the QMA’s analysis, Dr. Nohr asked Annual Day attendees if there was a future for physicians, given the health network’s current challenges.

In his view, the medical profession cannot be separated from the society it serves, which grants it its “professional” status. Unfortunately, in recent years there has been a loss of compassion, availability, accountability, interest in public health and altruism—all of which form the basis of professionalism—by physicians.

This has led to a change in the way physicians are viewed by the public. Alberta faces the same access and availability issues as Québec. And while Alberta’s physicians may not have received the same pay increases as Québec’s physicians in recent years, the province’s annual health budget has risen by as much as 7.5% “for the sole reason that physicians kept increasing their workload,” which the province was no longer able to sustain. There has also been a flagrant lack of services in rural regions because growing numbers of physicians wish to practise in urban centres. Yet, “it is the responsibility of physicians to ensure physicians are available throughout the province,” stated Nohr.

“Out of basic compassion, they should adopt a ‘what’s good for the goose is good for the gander’ approach,” he stressed.

Understanding the value of productivity to the common good

In his former role of president of the AMA, Nohr took steps to explain to both physicians and the government that the status quo was not sustainable and that they had to work together to improve the situation. In his view, “trust is the basis of a productive relationship.” This applies to colleagues as well as patients. For the medical profession, this will have to begin with the realization that it cannot “remain a monopoly focused on its own interests.”

The solution is to go back to basics and provide inspiration rather than impose a particular viewpoint. For this to happen, there must be a common understanding that healthcare should revolve around the patient. Physicians must let go of the notions of providing care to and for the patient, and instead adopt an approach of working with the patient.

This type of awareness would be impossible without the understanding that productivity should not be measured in terms of the volume of patients that a physician can manage, but rather, the value of the care provided.

To achieve this, physicians must participate in the “judicious and conscientious” management of the resources entrusted to them.

Responsible management through collaboration

This is the responsible management approach Nohr attempted to implement during his presidency. It is an approach wherein the success of one depends on the success of the others and within which the individual is inseparable from the collective. It is one that is achieved through collaboration, not confrontation.

The AMA eventually came to an agreement with the government to resolve the two main issues in Alberta: (1) finding “the physicians we need to practise in rural regions and being able to send them there,” and (2) relying on appropriateness of care as a way to limit the increase in the healthcare budget, which physicians committed to reducing from 7.5% to 4%.

In response to a question from one of the Annual Day attendees, who wanted to know how Dr. Nohr had managed to convince 78% of AMA members that these reforms were necessary, Nohr explained, “I did my best to persuade them that it was in our best interests. When it comes down to it, if we can share a vision of what is possible, we can get everyone on board.”

HugoJAMQ7
To close the day, QMA president Dr. Hugo Viens stated that the report stemming from the consultations undertaken during the professionalism tour marked the beginning of a new process. “It’s clear that more than ever, physicians must develop a shared vision of their profession and commit to renewing the social contract,” he emphasized. Results from the tour indicated that physicians support the four avenues for action proposed by the QMA: leadership, professionalism, clinical governance and medical organization.

And although it is not yet clear to many physicians what form these actions will take, the fact that they believe in the process is “a step in the right direction,” according to Viens. It also signals to the QMA that it must continue to be proactive in facilitating the implementation of solutions and supporting the physicians who commit to them.

Developing a performance-oriented medical organization

Through its interactions with the other provinces, the QMA has recognized that the stakeholders who succeed in moving things in the right direction are those who take control of their medical organizations with a view to performance. Recent studies on the compensation of physicians have reached the same conclusions. Viens pointed out that “if we ignore the sociopolitical noise that surrounds them, these studies clearly demonstrate that performance within health networks is most strongly influenced by medical organization, not by our pay scales or misunderstood bonus systems, which are what get talked about the most!” 

The QMA is already very committed to the development of medical leadership and will continue in this direction. Along with its members, it also intends to pursue its campaign against overdiagnosis and overmedication, which was initiated several years ago. Viens stressed the importance of continuing to educate physicians, decision makers and patients through training and tools, and of assisting local leaders who are taking steps to implement changes in practice that encourage relevance in their respective settings.

The role of physician executives—which is one of leadership—must be recognized as such by their physician colleagues and by the various clinical, administrative and governmental authorities. The QMA’s Physician Executives Group is an effective instrument in their continued promotion.

At present, however, the main focus is medical organization. Current frameworks do not allow physicians to work together. The medical community must learn to collaborate and the QMA intends to further this issue. The challenge is a real one and it may push the association to reinvent itself in order to mobilize the resources required to carry out the task.

Solutions lab for FMG/institution co-management– May 11, 2018

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Solutions lab for FMG/institution co-management– May 11, 2018

 

Do you manage an FMG or institution and are interested in co-management?

There is still time to register for the solutions lab offered by the QMA.

This is a training approach that focuses on interactions between participants to improve professional practice. During a one-day workshop bringing together physician executives and clinical administrative managers, participants each share a situation they have experienced that is then studied by the group.

By the end, participants will be able to expand their capacity for action and reflection, be more efficient in their professional practice related to their management functions and also be able to apply a collaborative approach to resolving complex problems experienced in their professional practice.

This accredited training will be led by Marie Côté and André Fortin. Ms. Côté is an expert in organizational development, transformation, coaching and co-development at La Gestion Réinventée, a firm she created in 2016 after publishing her book La Gestion réinventée : l’avenir est entre vos mains. Mr. Fortin has been advising businesses for 25 years. He is interested in innovation processes, collaborative approaches, and promotes a participatory, rigorous vision that builds on the collective intelligence of groups and the diversity of individuals.

This activity will take place in Montréal on May 11, 2018 and will be followed by an on-line exit meeting on June 8 or 15, at the participants’ preference.

You can still register by visiting the services offered for Physician Executives on the Web site.

 

Upcoming courses offered by the QMA

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Upcoming courses offered by the QMA

Medical leadership training – PLIlogo leadershipmedical

  • Mobiliser les autres (engaging others) – MONTRÉAL – May 23 to 25, 2018 (in French only)

 

How to succeed in an environment that encompasses different functions and cultures? This course aims to improve your ability to influence and engage others in order to gain their cooperation and commitment to reach a given organizational vision in the health care setting.
CPD credits: 17.25

 

  • Négociation et gestion des conflits (negotiation and conflict management) – SAGUENAY – June 6 to 8, 2018 (in French only)

This course will enable you to develop strategies to manage conflict within an organization, avoid the difficulties that conflicts can create, and learn how effective management of conflict can enhance creativity and innovation. Through a negotiation exercise, you will develop a planned approach and practise successful techniques to achieve results in interpersonal relations.
CPD credits: 21

 

  • Orchestrer le changement et l'innovation (leading change and innovation) – SAGUENAY – September 19 and 20, 2018 (in French only)

How to align people and organizations to build a shared vision and commitment to act is the central theme of this course. Using change management theories, you will learn to develop strategies to motivate, implement and sustain change, while also overcoming opposition to change. Through the presentation and discussion of issues and concrete exercises, you will cover different topics that include creating a resilient work environment and dealing with the impact of change.
CPD credits: 14

To find out more and to register, go to www.amq.ca/formation or write to admin@amq.ca.

 

The QMA recognizes 50 years of practice

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The QMA recognizes 50 years of practice

Once again, this year 12 member physicians of the Québec Medical Association were recognized for their 50 years of practice. Every year, the QMA recognizes the successful continuing careers of physicians who are still active in treating their patients. Over the next few days, each one of them will receive a plaque highlighting their contribution to the community. 

The physicians being recognized are:

  • Dr. Robert Prescott
  • Dr. Lily Trokenberg-Hechtman
  • Dr. Robert Dubé
  • Dr. Rénald Giroux
  • Dr. Richard Guimond
  • Dr. Micheline Ste-Marie
  • Dr. Alain G. Verdant
  • Dr. Maurice Somma
  • Dr. Jacques Beaudry
  • Dr. Réal Dallaire
  • Dr. Jacques Thivierge
  • Dr. Pierre L. Turgeon

Congratulations to all and thank you for your commitment!

To learn more, write to admin@amq.ca.

 

Presenting the 2018-2019 Board of Directors

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Presenting the 2018-2019 Board of Directors

Two new members joined the Board of Directors of your association at its Annual General Assembly on Friday, April 20, 2018. Dr. Adam E. Hofmann and Alexandre Elhalwi (student representative) joined the directors already on the Board. The members of the 2018-2019 Board of Directors are:

  • Dr. Hugo Viens, President
  • Dr. Vincent Demers, Vice-president
  • Dr. Yun Jen, Outgoing President
  • Dr. Michèle Pelletier, Treasurer
  • Alexandre Elhalwi, Director *
  • Dr. Adam E. Hofmann, Director *
  • Dr. Frantz-Daniel Lafortune, Director
  • Dr. Abdo Shabah, Director
  • Dr. Guylène Thériault, Director
  • Dr. Michel Welt, Director
  • Normand Laberge, Executive Director

* New Board members

We would like to thank Dr. Isabelle Samson, who is leaving the Board after five years as a director, including one as vice-president, for her commitment to and support on the organization’s major issues, including the professionalism component and the resulting tour across Québec. We would also like to thank Aline Demirdjian Khatchikian, medical student, for her contribution as a director over the past year.

 

When a CPDP decides to do something about overdiagnosis

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Whenever it meets with physicians in their environment, the QMA has observed that many of its members are committed to improving care and services on a daily basis. Great initiatives are taking shape everywhere. Some of them should even be implemented or adapted elsewhere, but for this to happen, we need to know that they exist! 

If you have set up a project that deserves more visibility or if you know of members colleagues who have done so, feel free to contact us at communications@amq.ca. We would be pleased to showcase your achievements.

When a CPDP decides to do something about overdiagnosis

Overdiagnosis, overmedication, overmedicalization… we all now know about the harmful effects of unnecessary tests, treatments and procedures. But it is not easy to change one’s daily practice. Nevertheless, some environments are acquiring the means to improve the appropriateness of care. One example is the CISSS de Laval, with its lab test optimization and appropriateness committee, and its ongoing medical training committee that Dr. Mark-Andrew Stefan, a public health and preventive medicine specialist, tells us about today.

A little over a year ago, the CISSSS de Laval’s Council of Physicians, Dentists and Pharmacists (CPDP) decided to make tackling overdiagnosis its priority. To do so, it started by expanding the mandate of the lab test optimization and appropriateness committee.

“The four lab departments that were part of it realized that they could not really change the practices of prescribers by themselves,” explains Dr. Stefan. Besides representatives from the pathology, microbiology, hematology and biochemistry services, the committee now also has representatives from all the clinical departments, from emergency to surgery, including pediatrics, family medicine and obstetrics.

Tackling the lists of tests for check-ups

This much “broader and more representative” committee can take the concerns and ideas of the prescribers themselves into account. It has also increased in stature. It has become a permanent fixture thanks to the power it has been given by the CPDP, and is an interesting approach for improving appropriateness because it is involved with the actual decision-making process.

We must systematically refer to the committee to get approval for a new check-up, a new collective prescription or a modification to any existing ones. This enables us to “at least avoid worsening overdiagnosis,” even if it seems we are “opportunistic”, points out Dr. Stefan, because we are being “reactive”.

During these meetings, held every six weeks, the committee examines the appropriateness of the tests requested on the forms. “We have often had to remove tests that we felt were not appropriate or reduce their frequency. So just by doing that, we can have an impact on overdiagnosis,” Dr. Stefan explains.

Targeting priority projects

However, the committee wanted to go further and be pro-active. It therefore decided to target five projects every year deemed to be a priority that could impact lab tests or medical imaging. For instance, Dr. Stefan is in charge of a pap test sub-committee. “With pathology, family medicine, obstetrics-gynecology, we want to look at how we can reduce the frequency of pap tests in order to follow the schedule recommended by the learned societies, since we know that some women needlessly continue to have pap tests every year.”

The first five priority projects have all been identified with inspiration from Choosing Wisely. The committee will conduct monitoring to determine the “starting point, but also to see if the strategies implemented have changed anything”.

It is not that simple to change practices. While ongoing training is needed, it is not sufficient and must be accompanied by other strategies. It does not work if a workshop is organized or a speaker is invited without doing anything else. It may also be necessary to change usage rules, redo formulas when they are the reason behind overdiagnosis, and sometimes even compare the practices of physicians in order to harmonize them. “It’s not about naming physicians who have irregular practices compared with others. But we know that physicians hate to be the worst ones because they are very competitive. So if we can show them that their colleagues are doing things better than they are, they will look at their own practices and quickly modify them!” says Dr. Stefan.

Training

For its part, the ongoing medical training committee, which is also overseen by the CPDP, has been given the mandate to always “focus on appropriateness”. As a result, in the last two years, not only has it organized several training sessions centred wholly on the appropriateness of care, but every workshop on other topics – there is about one session every month – must cover the aspect of overdiagnosis, for instance by highlighting the Choosing Wisely recommendations related to the topic, even if this is not the main message.