Quebec Liberal Party promises

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2018 Quebec Election

While Quebec is immersed in the election campaign, the QMA is closely monitoring the commitments made by the various political parties in the area of healthcare and social services. Between now and October 1, we will share with you our summary of the policy directions and promises of the various political parties.

Quebec Liberal Party promises

New targets for family physicians

The Quebec Liberal Party (QLP) does not plan to revisit the agreement it signed with the medical specialists. However, family physicians would be penalized by a Liberal government if they fail to meet the target of 90% of the population having a family physician by 2022, which means taking 900,000 more patients.

When passed into law in 2015, Bill 20 also made provision for financial penalties for general practitioners if less than 85% of the population had access to a family physician by the end of 2017—the measure is currently suspended. Outgoing Premier Philippe Couillard also committed to a 95% attendance‑at‑work record observed by general practitioners by the end of a possible second term.

A number of measures for seniors

Living conditions in residential and long-term care facilities (CHSLDs) were in the news for several months last year: quality of food, number of baths provided, staff working conditions, air conditioning, etc. Care for seniors has clearly become a major election issue for which all of the parties are proposing solutions.

For their part, the Liberals have made a commitment to continue a pilot project that involves looking at nurse-patient ratios, creating 1,500 new places in residential and long-term care facilities, and setting up a telephone help line for seniors wishing to break out of their social isolation.

An additional $50 million per year would be invested in home care, on top of the current $150 million, and families with a live-in senior relative or friend will receive a tax credit for home renovations. 

Continuity

A number of QLP commitments are intended to continue the work already started during their most recent term. In fact, if re-elected, the Liberal Party will open 25 additional super clinics to supplement the 50 already promised, including the 49 in service. Similarly, the Liberals will continue working towards its objective of deploying 2,000 “super nurses” in the healthcare system by 2024−2025.

Other healthcare promises:

  • Expanded dental care coverage;
  • A 4.2%-per-year increase in funding for facilities, if the state of the economy allows;
  • An increase of $50 million per year for home care, on top of the current $150 million.

 

 

 

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Québec Solidaire promises

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2018 Quebec Election

While Quebec is immersed in the election campaign, the QMA is closely monitoring the commitments made by the various political parties in the area of healthcare and social services. Between now and October 1, we will share with you our summary of the policy directions and promises of the various political parties.

Québec Solidaire promises

Increased dental care coverage

One of the core promises of Québec Solidaire (QS) is full, publicly funded dental care coverage for children and teenagers under age 18. Individuals over age 18 would be reimbursed up to 80% (cleaning and preventive care) or 60% (curative dental care).

According to the Léger polling firm’s barometer of political promises, QS is spot on with this proposal, which ranks second among the most popular commitments, just below the Coalition Avenir Québec party’s promise to reduce wait times in hospital emergency rooms to 90 minutes.

Critics doubt that such a measure, estimated by QS to cost $950 million per year, is realistic or reasonable. Québec Solidaire justifies the scale of its investment by the significant costs currently covered by the public healthcare system, given that 5,700 children undergo dental surgery under anesthesia every year because of a lack of preventive care.

Physicians’ remuneration: “putting an end to the hemorrhaging of public funds”

Québec Solidaire plans to use this second commitment to fund the first: reduce the remuneration for medical specialists by 12% to enable the government to recover $925 million.

Like the Parti Québécois and the Coalition Avenir Québec, QS would like physician remuneration methods to be reviewed, but it is clear that a Québec Solidaire government would reintroduce salaries in public institutions.

Other healthcare promises:

  • Expanded home care services;
  • Local community service centres (CLSCs) open 24 hours per day, seven days a week;
  • A universal, publicly funded drug insurance plan (RAMPU);
  • A public agency, Pharma Quebec, to oversee the bulk purchasing of pharmaceuticals, generic drug production and pharmaceutical research and innovation.

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[1] Élections provinciales: quelles promesses sont les plus populaires?, Journal de Montréal - August 2018

[2] Québec Solidaire website

[3] Gabriel Nadeau-Dubois's Facebook page

 

 

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2019 Canadian Conference on Physician Leadership

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2019 Canadian Conference on Physician Leadership

The next Canadian Conference on Physician Leadership, co-hosted by Joule and the Canadian Society of Physician Leaders (CSPL), will be held in Montréal on April 26 and 27, 2019.

At this annual event, the CSPL brings together several hundred physician leaders from across Canada and gives them an opportunity to supplement their clinical expertise with practical leadership, management and networking skills and celebrate physician leadership.

During the conference to be held at the Queen Elizabeth Fairmont Hotel, a number of guest speakers will give presentations around the theme of "Diversity, Inclusion and Engagement: The Leadership Challenge."

Pre-conference courses will be given on April 24 and 25, 2019.

To obtain additional information on this event, visit the Canadian Conference on Physician Leadership website.

 

 

Symposium for Physician Executives on the theme of conflict prevention

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Symposium for Physician Executives on the theme of conflict prevention

Visuel Home ColloqueMG2018 ENConflict is part and parcel of the life of a work team. As a physician executive, you have the special task of managing a team of self-employed physicians, which makes your managerial role a bit more complex. Your experience tells you that is impossible to avoid all conflicts, but you can certainly hone your ability to anticipate them and introduce good strategies to minimize their negative impact.

This is what you will learn at the QMA’s 4th Symposium for Physician Executives, during which a number of guest speakers will give presentations around the theme of "Conflict Prevention: From Confrontation to Collaboration". The symposium will be held at the Hotel Vogue in Montréal on Friday, November 30, 2018.

The preliminary program is available on the Symposium website (In French only).

The registration fee of $370 is the same as last year. Since places are limited, you are advised to register soon, if you would like to attend.

To access the registration form, click here or go to colloqueamq.ca.

 

 

 

Twitter and Facebook messages of the month

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Are you interested in the latest medical news, the future of the medical profession and health issues? Then join our community in the social media, where the opinion leaders express their views! Our communities are growing. Follow us and connect with us!

twitter @amquebec

facebook www.facebook.com/AMQ.QUEBEC

 

Messages on Twitter

 

 

 

 

 

 

 

 

Messages on Facebook

 

 

 

 

 

 

 

 

 

 

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Finding innovation in the unlikeliest of places

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Finding innovation in the unlikeliest of places

Sometimes, all it takes is looking at an issue from a different angle to realize you need to think differently if you want to come up with innovative solutions.

In medicine, there’s no such thing as routine. It’s great to have set protocols, but there will always be a case that doesn’t fit with what we’ve learned. Maybe that’s why we value our independence so much, but also why we’re able to think outside the box.

I recently saw proof of this again during the Health Summit organized by the CMA. Hundreds of participants—many of them physicians, but also patients and caregivers from a wide range of backgrounds—got together to discuss ways to prepare for the future in healthcare. The objective, of course, was not only to figure out how to best apply current and future technological advances, but also, in broader terms, to ask ourselves how we can create environments where innovation can help us to improve and democratize healthcare.

If this sounds a lot like the QMA’s mission, it’s because we’ve spent years encouraging physicians to get involved, be agents of change, be aware of their professional responsibilities, and, in short, be professional.

Quite often, however, we see innovation through the micro-lens of new technologies and think of it as a new gadget or a so-called smart device that will finally allow us to throw away our fax machines much like we abandoned VHS cassettes and CDs when we started downloading movies and music.

But innovation is much more than that. It’s the ability to re-invent how we admit patients to a family medicine group so that they’re assigned to a medical team instead of simply being considered part of a physician’s patient roster. It’s the ability to bring medical scribes into emergency rooms to help make physicians more efficient. It’s having the flexibility to adopt a new treatment for a disease, while being able to question old habits because recent studies show that a routine screening test may not be the best option. It’s also being able to talk to our patients in a way that lets them make informed choices about their health.

We also need to accept new ways of providing healthcare, which the Mouvement innovation santé encourages us to do. In our day-to-day activities, we are seeing more and more examples of new practices, such as virtual clinics and remote consultations. And because the population seems to be ready for them, it’s time we start considering working with new healthcare partners in the private sector or the technology sector in order to make covered healthcare more accessible.

Of course, some of these innovations will work and be embraced, while others won’t be around for very long, but we still have to give them a chance and agree that mistakes are sometimes a necessary part of moving forward. All the physicians I’ve seen who innovate—whether by coming up with a new organizational practice, starting a business, designing a software, developing a new stent or orthopedic screw, adopting new practices, or simply questioning their old ways—all had one thing in common: A desire to look beyond the confines of their individual practices.

No matter what project they were working on, these people all resolved to do better and to try something new. With the provincial election just around the corner and uncertainty about the future of our healthcare system looming, I’d like to thank everyone who works hard to make the system better, or to improve the way they do things or interact with patients, because our common goal is ultimately to improve the health of patients and the general population.

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

 

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Mouvement innovation en santé

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Mouvement innovation santé

Various healthcare system partners who believe in innovation to improve the delivery of healthcare have joined together to launch the Mouvement innovation santé.

Every day, players of this healthcare innovation movement supported by QMA find that more and more healthcare entrepreneurs are investing in the healthcare system, and proposing initiatives to help meet the many needs of the population without Quebecers having to spend money to obtain care covered by the Régie de l'assurance maladie du Québec (RAMQ). They feel it is time to shift into high gear, raise awareness of these innovative solutions and facilitate the implementation of other initiatives involving external partners, such as private firms, non‑profit organizations and cooperatives. 

ACTION Mouvement Innovation

Several European countries have a public system based on the principles of universality and equity in healthcare delivery, and nonetheless promote a varied range of service providers. In Quebec, although the private sector is very much involved in the healthcare system, its involvement is poorly understood, if not frowned upon. However, the public is more and more open* to increased participation by private facilities, cooperatives and non‑profit organizations in the delivery of healthcare and health services.

 

 

There is also evidence in support of this trend. For example, École des Hautes Études Commerciales of Montréal (HEC Montréal) researchers have demonstrated that in Canada, a country ranked among those recognized for the performance of their healthcare system, the private sector makes a significant contribution to the delivery of healthcare.

To learn more about the Mouvement innovation santé and about initiatives implemented in Quebec, visit innovationsante.ca.

*Marie-Hélène Jobin et al., Des idées en santé pour le Québec, Rapport de recherche du Pole‑santé HEC Montréal, April 2017.

 

 

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Practising Wisely: Results from the participant survey

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Practising Wisely: Reducing Unnecessary Testing and Treatment

Results from the participant survey

 

 

 

When providing harm-free care becomes a vocation

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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 QMA. We would be pleased to showcase your achievements.

When providing harm-free care becomes a vocation

MEMBRE RenéWittmerAs soon as he started medical school, Dr. René Wittmer, currently an instructor in the Practising Wisely: Reducing Unnecessary Testing and Treatment  program*, wondered about the hidden aspects of overdiagnosis. While he was doing community health internships, he was impressed by discussions on the importance of the population-based approach and the need to understand that, because resources are limited, they must go to the right place for the right people at the right time. He says that “this encouraged me and some colleagues to read up on some screening programs to ascertain how solid the supporting evidence was.” He concluded from what he read that overdiagnosis is inherent to systematic screening. Once he became aware of this complex issue, he decided to do more in-depth research and see how he could reduce the negative effects of overdiagnosis in his day-to‑day practice.

Dr. Wittmer is a local community service centre (CLSC) and university family medicine group (UFMG) family physician, and teaches residents and medical students. He has a varied practice that includes following up with patients in his office and tending to patients in home care settings, in blood-borne and sexually transmitted infection (BBSTI) clinics, and at Notre Dame Hospital.

Having developed a keen interest in combatting the problems of overdiagnosis and over-medicalization, it was quite natural for Dr. Wittmer to want to verify whether the program set up by the Québec Medical Association and the Quebec College of Family Physicians (CQMF) could meet his needs and fulfil his aspirations. 

From participant to facilitator

When participating in a workshop, he quickly realized that he saw himself involved in this training. “I found that the message they were communicating was relevant and similar to what I had already been trying to communicate in my practice and to my medical residents. Nowadays, I continue to convey that message in my day-to-day activities,’ he explained.

Dr. Wittmer says that the Practising Wisely program is really distinctive, not only because it provides access to tools, but also because the program instructors are facilitators, first and foremost. “Many of the messages that participants retain come from the group discussions they have,” he explained. The moderators are there primarily to facilitate discussion and provide supporting evidence: “the participants draw their own conclusions,” he added. The idea is to encourage people to assess their practices and see how they can curtail overdiagnosis and over-medicalization.

“Everything is there in black and white,” says Dr. Wittmer. During the day, participants discover case studies they can use to assess how they use certain tools in a given situation and how to deal with obstacles that might arise in their day-to-day activities.

Tools that can be used to adopt new practices

Like the vast majority of physicians, residents and other clinicians participating in this program, Dr. Wittmer adopted new ways of doing things (see the results of the survey of workshop participants). “I had notions of overdiagnosis and how to curtail it, but I didn’t have tools to curtail it in my practice within a limited period of time,’ he explained. With the training, he discovered how to incorporate shared decision-making tools into his daily practice, particularly clinical decision-making tools and tools for explaining decisions to patients.

“Every day, I use Canadian Task Force on Preventive Health Care tools,” Dr. Wittmer pointed out. “This Canadian task force focusing on prevention and screening reviews literature and frontline clinicians’ recommendations for frontline clinicians. Their decision-making tools for the screening of various cancers are very well developed and explained in simple language.”

Family physicians also use the Absolute CVD Risk/Benefit Calculator posted online by James McCormack (and the French version was created with the assistance of Dr. Guylène Thériault, a member of the QMA Board of Directors). James McCormack, a professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver, is a passionate advocate of optimal use of medications and of evidence-based medicine.

His calculator can be used to estimate the risk of cardiovascular disease with the help of diagrams, smiley faces and sad faces. It also makes it possible to easily visualize the benefits and risks of a medical treatment, based on a patient’s personal information.

“We know that statins are a class of drugs that are frequently prescribed for cholesterol, and the advantage of this tool is that it can be used, in real time, not only to compare the effectiveness of a medical treatment, but also to see how effective the treatment is, compared with no treatment or alternatives, such as quitting smoking, changing one’s diet or increased physical exercise.”

Another benefit is that the calculator shows patients that treatment methods such as taking aspirin or vitamin supplements will not be beneficial in their case. “I turn my screen and allow my patient to see it. Together, we can calculate the intervention that will have the greatest benefit for their cardiovascular health, and the patient sees it in real time,” Dr. Wittmer explained.

International conference participants agree to take action

This summer, Dr. Wittmer and Dr. Guylène Thériault participated in the 6th international conference on Preventing Overdiagnosis, held in Copenhagen from August 20 to 22, 2018 (read the Overdiagnosis and overmedicalization: turning data into reduction article). He was impressed at discovering “this community whose existence I was unaware of and seeing that this interest in preventing overdiagnosis exists not only in Canada, but around the world. People agree that it is a major problem in our healthcare systems and that we need to take action.”

Although the issues appear to be the same in various countries, Dr. Wittmer believes it is still important to be able to quantify these problems that we are all aware of if we want to be able to take action. “We know, for example, that backache, which are one of the most frequent reasons for going to see a physician, are seldom pathologies for which it is necessary to take action because they are usually problems that people can solve themselves. However, based on the studies that participants have conducted in their communities, we could see evidence showing that opiates, which are not generally recommended for acute pain, are nonetheless overused, and that there is over-utilization of hospital resources for this type of problem.”

*The Practising Wisely: Reducing Unnecessary Testing and Treatment program is provided in Québec through a collaboration between the Québec Medical Association (QMA) and the Quebec College of Family Physicians (CQMF). This program was developed by the Ontario College of Family Physicians (OCFP).

 

 

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August 2018 survey results

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AUGUST SURVEY RESULTS: 

Can healthcare promises influence your voting decision in the next provincial election?

 

 

 

 

 

End-of-life care survey

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Overdiagnosis and overmedicalization: Turning data into reduction

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Overdiagnosis and overmedicalization: Turning data into reduction

ACTION GuyleneTheriault

From left to right: Dre Geneviève Bois, Dre Guylène Thériault et Dr René Wittmer
Photo credit: @GenBois 

Dr. Guylène Thériault, who has been a family physician since 1996, and is a graduate in evidence-based healthcare from Oxford University in England and a founding member of Choosing Wisely Canada’s clinical leaders group, has made it her mission to reduce overdiagnosis and overmedicalization. In addition to her clinical duties and research interests, Dr. Thériault has taught evidence-based medicine and shared decision-making to students, residents and physicians for several years. She has also been a member of the Québec Medical Association’s Board of Directors since April 2016. It was in this capacity that she attended the 6th international Preventing Overdiagnosis conference, held in Copenhagen from August 20 to 22, 2018. The QMA asked Dr. Thériault to discuss her experience at the conference and to describe her vision of the ongoing fight against overdiagnosis and overmedicalization.

QMA: You attended the 6th international Preventing Overdiagnosis conference in Copenhagen last August as a representative of the QMA, is that correct?

Dr. Thériault: Yes, Dr. Yun Jen and I both attended as representatives of the QMA. Along with Dr. Geneviève Bois of the Québec College of Family Physicians and Dr. René Wittmer, a facilitator for the Practising Wisely: Reducing Unnecessary Testing and Treatment program, we presented the findings from Québec. In preparation for the conference, we analyzed data from the past year. We found that six weeks after having participated in the Practising Wisely workshop, over 94% of participants had modified at least one of their practices, which was astonishing. After twelve weeks, we asked them if they had modified a second practice, and almost 83% had done so.

ACTION RésultatsRapportPratiqueÉclairée1 ENG  ACTION RésultatsRapportPratiqueÉclairée ENG

Graphs extracted from the analysis of surveys from the
Practising Wisely: Reducing Unnecessary Testing and Treatment program.


QMA: How did the participants react to your presentation?

Dr. Thériault: Very well. We received several questions as well as three requests to share our training program, specifically from Israel, the United States and the Netherlands.

QMA: This was the 6th edition of Preventing Overdiagnosis. Have you seen any progress in the fight against overdiagnosis and overmedicalization on an international scale?

Dr. Thériault: While it’s true that knowledge has continued to evolve, there has not been much advancement in the tools we have to fight the phenomenon. I attended a workshop in which we discussed how concepts related to this issue could be incorporated into medical programs from day one to become an integral part of training at all levels. However, the conversation quickly reverted to simply adding a curriculum—a few hours here and there—to the general program. The problem is that this will never solve the issue of the hidden curriculum. It’s a well‑known fact that young people learn mainly by watching what other physicians do.

QMA: Would you prefer that overdiagnosis and overmedicalization be discussed in each of the disciplines they are taught?

Dr. Thériault: If students are told to perform this, that and the other test for each type of disease, they will of course learn them by heart. But if we instead discuss the relevance of each of the tests, their usefulness and the cases in which they are really necessary, future physicians will take a different approach. For example, there are many tests that can be done for fatty liver, but the treatment is always the same: The patient has to lose weight and eat well. So, rather than teaching physicians a formula, it may be more appropriate to teach them to ask themselves whether the test they want to prescribe will change the treatment or the patient’s well-being.

QMA: So the idea would be to integrate the question of relevance throughout the curriculum?

Dr. Thériault: I know it may sound utopian, but I’m fortunate enough to be involved in McGill University’s satellite faculty of medicine project in the Outaouais region, and I’m hopeful that we’ll be able to do things differently. I suggested the idea of providing specific training to the instructors—rather than the students—to make them aware of the issues and to ensure that they are able to integrate notions of relevance into their course content. We can design curricula for young people, of course, but I’m not sure that’s the way to change the professional environment, if the instructors themselves are not aware of the issues of overdiagnosis and overmedicalization.

QMA: Any other observations?

Dr. Thériault: At last year’s conference in Québec City, I found it interesting to hear from patients who were given the opportunity to speak to participants and to share their insights, but this was not repeated in Copenhagen. However, although no patients were present this year, the lineup of speakers was excellent. I also discovered that we’re not alone in having trouble engaging decision-makers on the matter of reducing overdiagnosis. In France, for example, there is controversy over their systematic breast cancer screening program. In 2015, Marisol Touraine, then minister of social affairs and health, ordered an independent report on France’s national breast screening program. She was looking for recommendations, given that only 52% of women underwent the systematic screening and that its relevance was being increasingly questioned in the scientific literature. The report concluded that there were two options: either put an end to the systematic screening program altogether, or rethink it to specifically target women at higher risk. In the end, the report was shelved for political reasons and the screening program has carried on unchanged.

QMA: So, have we hit a wall on this issue?

Dr. Thériault: While it’s useful to understand what’s going on and to advance knowledge through studies, we need to find ways to change the situation on the ground. We’re still not going far enough in asking ourselves how we can change existing practices. In Québec, and probably elsewhere, we still haven’t caught the attention of policy makers, in my opinion. At some point, the guidelines will have to come from above. If we had a minister who truly believed that overdiagnosis and overmedicalization were a problem, we could move forward. It’s one thing to identify and acknowledge an issue, but in order for the relevance committees to do their work, what’s needed is a clear direction.

QMA: Is progress still being made?

Dr. Thériault: Definitely. I recently read a newspaper article on the underutilization of medical imaging equipment that talked about the issue of relevance. Of course, it stated that more machines and more money are needed, but for the first time there was mention that irrelevance leads to overuse, overdiagnosis and overtreatment. I was glad because it showed that the message is getting through. The challenge is to follow through with effective action. Many clinicians and CPDPs have good ideas, but they are often not well received. In my experience, these initiatives are more often blocked by the administration than by physicians. Even if we replace an unnecessary test with a useful one, it’s still a test, and the equipment continues to be used just as often and there’s no direct effect on any specific budgetary item. On the other hand, any change to the status quo requires investment, so there must be a real willingness to do things differently and a deep understanding of the issue of overdiagnosis.

QMA: So, is it difficult to get people to take action?

Dr. Thériault: It’s not the same everywhere. In some of the places where I presented my ideas, actions were taken very quickly. It all depends on the environment. Not all managers are yet sufficiently aware of the issue of overdiagnosis and its effects on patient health. Some only see it from an accounting perspective. In their view, relevance doesn’t save money and in a way, that’s true. Let’s say a hospital has the capacity for 30,000 tests, but there’s a waiting list of 60,000 patients. Even if 30,000 non-relevant cases are taken off the list, the machine will still be running at full capacity. I can tell managers that they’ll save money in the end because relevance will ensure patients receive more appropriate treatment, but the way some decision-makers see it is that the same number of technicians will still be needed to perform the tests and, in addition, changing practices will take time and resources. It may be time to target managers and decision-makers in training sessions and conferences on overdiagnosis and overmedicalization, the same way patients were involved in the discussion at the 5th international Preventing Overdiagnosis conference that the QMA held in Québec City.

QMA: What can patients do to address this issue?

Dr. Thériault: Patients have a lot of power to change doctors’ habits. If they ask, “Doctor, do I really need this test?” their physicians will start asking themselves the same question. There may be a small number of physicians who will tell patients they shouldn’t ask questions, but they’re in the minority. The majority of physicians will wonder if there's more to the question...if there’s something else they should know. A long time ago, I started teaching my students to ask themselves questions about the cases they were seeing and to look for answers in the literature. After a few months, their bosses came to me to find out what I was teaching the students. They wanted to learn it too! It’s the same thing with patients. If they start asking questions, physicians will want to answer them, and if the physicians need more information, they will search for it or attend training sessions in order to be able to answer their patients’ questions.

 

Good to know

Dr. Thériault maintains a website with tools to help practitioners incorporate preventive practices in a clinical setting. Her Centre pour l'avancement des soins de santé factuels is intended as a starting point for the creation of a centre for evidence-based medicine in Québec.

 

 

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