Family medicine recommendation #2: Do not use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than 7 days’ duration.
What shared decision making strategies or tools have you implemented in your practice around these recommendations?
At Newcomers Health Clinic in Halifax, NS, we are the first point of medical contact for all refugees—even those not yet eligible for provincial health insurance. In recent years, our province has seen an influx of refugees from Syria who speak Arabic, and, more recently, of newcomers who speak Tigrinya, Somali, Amharic, and Spanish. Unfortunately, translated materials to help us engage our clients in conversations around Choosing Wisely recommendations and the common conditions featured in the College of Family Physicians of Canada’s family medicine list have been lacking. That is why I am very happy that Choosing Wisely Canada and the College have translated their patient-friendly antibiotic resources into multiple languages.
Requests for antibiotics are one of the most common clinical encounters. It is important to establish as early as possible that you will not prescribe antibiotics for a common cold or a viral illness, as this practice is not supported by evidence.
As Halifax is not a big city, networks of people speaking the same language, such as Arabic, create a strong sense of community, and translated materials offer an opportunity for knowledge transfer among community members.
What makes shared decision making around this topic challenging or rewarding?
Literacy, specifically health literacy, is the most important challenge I face with my patients. Many patients might not have complete literacy in their native language, so understanding health information and instruction in English is very difficult. We have professional interpreting services available in the clinic during all of our encounters, but translated patient materials supplement our discussion and alleviate the pressure of our interaction. Patients can take the information home and read it again, have it read to them, or share with family, friends, and the community.
Shared decision making encourages us to find common ground and to build relationships with patients, even though we do not speak the same language.
Why is shared decision making around this specific Choosing Wisely recommendation or clinical topic essential to you?
For medical, ethical, and personal reasons this recommendation and its translated materials are important to me. We are a transitional clinic, meaning patients will eventually transition to their permanent family physician. I want to help set them up for success in the Canadian health care system, part of which means ensuring they know when evidence supports a recommendation such as antibiotic use, when it does not, and how to appropriately use them. We all have a role to play in antibiotic stewardship and protecting against antimicrobial resistance. As a health system, we need to be more proactive and provide patient resources that are reflective of newly arriving immigrant and refugee populations.
As someone who immigrated to Canada myself, I know how heartwarming it is to see something available in your own language, even if you know English very well. It means that your language needs have been recognized as a priority—you are important. You feel welcome and valued. I am so grateful that Choosing Wisely Canada’s materials on antibiotic prescribing— the patient pamphlet Colds, Flu, and Other Respiratory Illnesses: Don’t Rush to Antibiotics, as well as the posters Sorry and Antibiotics: Three Questions To Ask Your Health Care Provider—are available in Arabic, French, Chinese (simplified), Punjabi, Spanish, and Tagalog. I hope that there are even more translated materials to come, particularly in languages that we highly need in our clinic such as Arabic, Somali, Tigrinya, Amharic, and Dari.
This article first appeared in Canadian Family Physician. The interview was prepared by Dr Kimberly Wintemute, Primary Care Co-Lead, and Hayley Thompson, Project Manager, for Choosing Wisely Canada.