Dr. Jose Francois
I’ve been involved with Choosing Wisely Manitoba since its beginning, and I’m pleased to be considered a Clinical Champion. Beyond each of the specific recommendations, we are encouraged as physicians to question the things we’re doing on a daily, patient-by-patient basis.
We’re challenged to reflect on the evidence and ask ourselves if what we’re doing is appropriate – it builds an almost automatic reflex reaction to everything we do; after all, not everything we do is beneficial, and we should be questioning the real clinical needs and risks for our patients.
I’m particularly interested in choosing our therapies wisely and a few of my pet interests include: medications typically prescribed for long periods of time (such as proton pump inhibitors), polypharmacy, and the long term value versus negative impacts and side effects of all medications we prescribe for our patients.
In my own specific practice, I am keen to participate and encourage all my colleagues to take quarterly medication reviews seriously and am especially interested in over prescribing and long-term use of antipsychotics, sedatives and the multi-pharma cocktails many of our geriatric patients. I recall one particularly elderly patient on multiple medications, including 3 different antipsychotics – she was barely ambulatory and virtually comatose. After our team case review, we designed a step-down regimen that ended with 1 medium dose antipsychotic and many fewer drugs; she became more mobile and cognitive – the family couldn’t believe how it was like she had been returned to them.
Often our medical team and the family fear the impacts and risks of reducing these medications, but in one of our units we were able to free up nursing time by reducing the number of medication “passes” – reducing the cycle and frequency of medication distributions to patients, and offsetting the time they were able to spend with each patient and support step-down regimens. Knowing that their loved one will have more attention is very reassuring to families who really want their granny not to be medicated so heavily, but fear change even if granny could be returned to them because they think “she’s doing so well”.
Choosing Wisely Manitoba has challenged, encouraged, and enabled us to examine many of our clinical practices – and I believe we are improving quality, improving the health system, delivering better care, and ultimately reducing wait times and saving health care dollars.