Share on Facebook Share on Twitter

Expectations versus reality when Choosing Wisely

by: Dr. Elliot Lass for Canadian Family Physician

“So…are you going to prescribe me the antibiotic, doc?”

He was an otherwise healthy male in his 40s seen in after-hours care and I had just diagnosed him with a viral upper respiratory infection. I was in my first month of my family medicine residency and there were six other patients waiting to be seen for other urgent issues. I was falling behind in clinic and I had a whole day of clinic notes to catch up on. Suddenly, the years of my training in Choosing Wisely recommendations all seemed trivial.

During my summers in medical school, I had the opportunity to work at the Choosing Wisely Canada central office on two projects.  As a result of this experience, I am a passionate advocate for the campaign.  My first project evaluated patient education materials (one of which centred around antibiotic use in viral upper respiratory infections) in Family Health Teams throughout the Greater Toronto Area1.  I also helped to co-create STARS (Students and Trainees Advocating for Resource Stewardship), a student-led campaign across all of Canada’s medical schools in support of Choosing Wisely Canada 2.

As I looked at the patient in front of me, I was aware of the numerous drivers for why clinicians prescribe medically unnecessary antibiotics and I felt like I was about to be driven down that path.  Time pressures are always on our minds.  As physicians we want our patients to leave the clinical encounter satisfied, and sometimes it’s easier to send the patient home with a prescription than to have a potentially time-consuming conversation about why the antibiotic is not necessary 3.

One of my mentors in family medicine has taught me that in our short visits, one of our goals is to find out the “patient’s agenda”.  Two weeks into my residency, I felt tested by this situation where the patient’s agenda and mine were so far apart. I thought back to my education in medical school where we learned that antibiotics are not benign drugs.  By prescribing an unnecessary antibiotic, we are fueling antibiotic resistance and creating the possibility that the antibiotics I prescribe for him today will not be useful tomorrow4.

This article first appeared in Canadian Family Physician. Please click here for the full article. 


Back to Perspectives