Family Medicine Recommendation #5: Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient.

Choosing Wisely Canada: How have you implemented this recommendation in your practice?

Dr. Anthony Train: This is the broadest and biggest recommendation I’m focusing on because I have quite a young professional population. They are health conscious, and a lot of them wonder, ‘what do I need?’ This is when I open up the conversation about necessary care.

I have the Choosing Wisely posters in my exam rooms and the list of guideline-based screening maneuvers next to them. I usually talk about screening maneuvers, and then explain the ones that are applicable to that patient. I explain that most of the time at their age they’re not going to need blood work. This is the best recommendation to talk about for me: why you don’t need blood tests if you’re well.

CWC: How have you brought the principles of Choosing Wisely to your relationship with patients?

AT: I’m introducing them to the concept when I first meet them. I have a new practice, and I take on about five new patients daily.

Most of my conversations around appropriateness of care are very positive. My practice is downtown Calgary and you have quite a variety of people – everything from homeless people to lawyers and engineers – and they really appreciate having the conversation about what is necessary. They appreciate that you respect their intelligence. You’re being more inclusive; they’re able to engage in a two-way dialogue about their health. I think the days are over when people trust physicians at face value. People are increasingly sensitive to the concept of harm. Everyone knows someone who’s had a bad outcome in their medical care.

CWC: What does Choosing Wisely mean to you as a family physician?

AT: It is helping us to think twice about what we’re doing, and also to be better custodians of resources. People are being more environmentally conscious; they’re more aware of economic factors and constraints. I think now we’re showing leadership in medicine. It’s helping the profession to be more accountable to patients.

This article first appeared in Canadian Family Physician. The interview was prepared by Dr Kimberly Wintemute, Primary Care Co-Lead, and Hayley Thompson, Project Coordinator, for Choosing Wisely Canada.