To healthcare providers, Evidence-Based Medicine (EBM) and patient-centred care or shared decision making (SDM) are not new concepts.

We learn these in school and the theories and applications are constantly updated and disseminated via continued medical education. Medical learners provide new insights to their preceptors. Likewise, students absorb the practices being modeled around them. Seeing that your colleague does something a better way is a much more powerful force for change, than is reading an article online.

How can you share this or further improve on what you are already doing?

  • Discover some of the hands on resources that can aid in discussions with your patients and their families
  • Remember the context of the patient; use this to help begin a discussion about decisions. If you need help starting out with patient-centred care, try the FIFE Model.
    • In addition to our histories and physicals, we should asses the context of the person; it will be awkward at first, but gradually it becomes natural to ask (in your own way) about the following:
What are your Feelings about your health or the illness that brought you in?

Do you have Ideas of what it could be or why it happened?

How does it affect your daily Function, eg. does it affect your job or ability to look after your family?

What Expectations do you have, specifically, what are they hoping to get out of this visit? What are you hoping to hear? Is there a test, or treatment you think we should discuss?
  • Take the Confronting Unnecessary Care online CME; review the issue of unnecessary care in Canada, become familiar with the resources of Choosing Wisely Canada – a physician-initiated campaign that encourages physicians and patients to have evidence-informed conversations about the necessity of medical tests and treatments so as to eliminate unnecessary care.
  • Watch a video on good stewardship with clinical encounters from the National Physician Alliance (NPA); they suggest a a simple, 5-step plan to enable health care providers to discuss unnecessary tests and treatments with patients:
    • 1. Clarify what the patient's true concerns are
      2. Provide the patient with the information he/she needs to understand the plan
      3. Be courteous and respectful
      4. Provide clear contingency plan
      5. Make sure the patient is satisfied with the plan


What do you think healthcare providers can do differently? E-mail your thoughts or tweet them to @LessIsMoreMed