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Choosing Wisely in Practice

Dr. Declan Rowan talks about how he’s improving his practice by engaging clinicians in conversations and debates about Choosing Wisely Canada’s new recommendations.

Improving our practice

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care.

Recently 61 new recommendations were released. I was very keen for all clinicians in our Family Health Team to begin a conversation and debate about many of these recommendations. Check them out at

Through our EMR I sent a message to all clinicians about one Choosing Wisely recommendation. I posted it unedited and with no editorial comment. The whole idea was to lay it out and allow debate begin.

For example:

Do not advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits. While self-monitoring of blood glucose (SMBG) for patients with diabetes is recommended by certain groups to help monitor glycemic control, for most adults with type II diabetes who are not using insulin, many studies have shown that routine SMBG does little to control blood sugar over time.

This one has caused quite a bit of debate. While there’s no consensus as to what we all should do, each clinician is now examining some of the testing that we otherwise reflexively just requested in the past.

I initially began sending one message per day but found this was too often so I reduced the frequency to one per week. This allows time for debate to occur on our messaging system, in the hallway and in the lunchroom.

I think it is a great way to introduce these topics and foster a conversation among colleagues.

Dr. Declan Rowan
Regional Primary Care Lead
Champlain Regional Cancer Program

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