PRACTICE PARTNER
Avoid the
diagnostic
cascade
Conversations are the
test to Practising Wisely
DOC TALK
By Stuart Foxman
W
hen he came to Dr. Jobin
Varughese complaining of
palpitations, the patient
already had his own recom-
mendation: send me for a screening EKG.
“He had Googled it and thought this was
the way to go,” says Dr. Varughese, a family
doctor in Brampton.
Earlier in his career, Dr. Varughese may
well have obliged. “I was a lot more trigger
happy,” he admits. He wouldn’t fault any
colleagues for ordering an EKG under the
same circumstances – but only after an hon-
est conversation with the patient.
In this case, the patient was young and
healthy with no previous coronary issues. As
Dr. Varughese probed, it became clear that
the palpitations occurred when the patient
was stressed. His caffeine intake was also
high. Dr. Varughese talked about the pros
and cons of an EKG. The discussion raised
the point that if something was even slightly
off it might spark more tests. In the end, Dr.
Varughese and the patient agreed that an
EKG would likely yield nothing helpful and
was, for now, needless.
The vast majority of his diagnoses and ad-
vice, says Dr. Varughese, results from patient
physicals and histories. Doctors and patients
alike can be tempted – often to their detri-
ment – to turn to the abundance of tests and
treatments available.
“If it’s not going to be clinically useful or
beneficial, don’t do it,” says Dr. Varughese,
co-chair of the Practising Wisely Planning
Committee.
Practising Wisely, a program of the On-
tario College of Family Physicians, is aligned
with the Choosing Wisely campaign. That
national effort was launched in 2014 by a
team from the University of Toronto, Cana-
dian Medical Association and St. Michael’s
ISSUE 4, 2017 DIALOGUE
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