(Montreal) “Choosing Wisely” is a movement that is unfolding within the medical community to tackle over-medication and the prescription of unnecessary or low-value-added medical examinations for patients. While it is primarily aimed at their well-being, it has more recently been put forward also as a “gesture for the environment”.
–
–
–
Health professionals are increasingly questioning the impact of their work on the environment.
This is particularly the case of the members of the Association québécoise des médecins pour l’environnement (AQME) which recently held for five days the International Francophone Climate and Health Symposium, organized with the organization Médecins francophones du Canada, the University of Montreal (department of family medicine) and Synergie Santé Environnement.
The subject of “degrowth” has been the subject of several conferences, particularly with regard to its concrete applications in the health network.
The Dre Caroline Laberge discussed on this occasion the concept of “choosing carefully”: she had already taken an interest in it for the well-being of her patients, but recently, her thinking has also taken on an environmental dimension.
PHOTO FROM THE SITE OF THE QUEBEC COLLEGE OF FAMILY PHYSICIANS
The Dre Caroline Laberge
–
The family doctor at Gmf-U Laurier (family medicine group) in Quebec City explained in an interview that giving patients many exams, such as medical imaging or CT scans, often causes them a lot of stress and that some tests also sometimes present risks, as well as side effects. Often, she says, “we find small anomalies” during these examinations, as the medical equipment has become “powerful” and detects microscopic spots, which often turn out to be benign. There are also all these cases of “false alarms” and “false positives”, underlines the doctor who is also president of the College of family physicians.
“All of this requires follow-ups, biopsies, etc. We often see “a cascade of therapeutic examinations”, the first leading to another and so on, which can be tests “of low added value for the patient” – with the added bonus of periodic check-ups, and therefore new tests.
Among others, the College of Family Physicians of Canada has produced a thought-provoking document for general practitioners that states, among other examples: “Do not order chest x-rays and screening EKGs for asymptomatic or low-risk patients.” And “Avoid ordering thyroid function tests in asymptomatic patients”.
“The possible drawbacks of such systematic screening outweigh the potential benefits,” one of the examples reads.
The stress of medical examinations and side effects: “All this has an impact on the well-being of people, on their quality of life”, according to Dre Laberge.
We cannot ignore it, she says, and we must think about it for the benefit of patients.
However, it is obvious that diagnostic tests and treatments are absolutely necessary for many diseases: the “Choosing Wisely” campaign obviously does not advocate eliminating them.
And the planet?
Parallel to this reflection centered on the well-being of the patient, another has developed in relation to the environment. “Choosing with care” at the same time becomes a gesture of sustainable development.
During each examination, the patient and medical staff must travel to the hospital, which creates greenhouse gas (GHG) emissions. Ditto for sending tests to the laboratory, manufacturing drugs in a factory that uses resources and energy, and obviously, all this generates waste: we can think of those from nuclear medicine and also all these small pill packs. which end up in the landfill.
Dre Laberge also gives as an example the case of a specific type of asthma inhaler: it pollutes enormously, she says, and destroys the ozone layer.
” A pump [qui peut durer un mois] is the equivalent of a car traveling for nearly 300 kilometers, ”she emphasizes.
“Since I learned it, I have prescribed others”, unless they are contraindicated. She also mentions the case of those anesthetists who discovered that among their anesthetic gases used in the operating room, one was particularly harmful. They now prefer others to him.
Keeping the environment in mind is also that, according to the doctor.
The idea is not to offer poorer health care to protect the planet, she insists, but rather to ask this question: “for equivalent treatment, which one has the least impact?” environmental? ”
There is also the “nature prescription” initiative, which was discussed at the conference and which is gaining in popularity. A patient who has cardiovascular disease due to poor lifestyle habits may be prescribed medication, for example, to lower his blood pressure. These can have side effects and do not address the cause of the medical condition which may be sedentary lifestyle or smoking.
Instead, why not “prescribe” time in nature and physical exercise? she asks. “I am not doing it for the environment, I am doing it for the patient”, but at the same time, “the environmental cost does not exist if I prescribe nature”.
All this thinking to limit environmental damage is not a “mass” movement, says the family doctor. Rather, they are individuals who reflect on the impact of their actions on the health network.
She explains that doctors are trained to treat the individual who comes to see them, not the community – except for public health doctors, she says.
And while it can sometimes be at odds, health and the environment can also go hand in hand, she points out.
–
