Physician perspectives on Choosing Wisely Canada as an approach to reduce unnecessary medical care: a qualitative study

Abstract

Background: Reducing monies spent on unnecessary medical care is one possible target to improve value in healthcare systems. Regional variation in the provision of medical care suggests physician behaviour and patient demands influence the provision of unnecessary medical care. Recently, Choosing Wisely campaigns began using 'top 5 do-not-do' lists to target unnecessary medical care by encouraging greater physician and patient dialogue at the point of care. The present study aims to examine the rationale for Choosing Wisely Canada's (CWC) design and to analyse physician perceptions regarding the features of CWC aimed to reduce unnecessary medical care.

Methods: The study involved semi-structured interviews with 19 key informant physicians with CWC experience and the application of procedures of grounded theory to analyse interview transcripts and develop explanations addressing the objectives.

Results: Participants reported that the CWC was the medical community's response to three pressures, namely (1) demand for unnecessary medical care from patients during the clinical encounter; (2) public perception that physicians do not always prioritise patients' needs; and (3) 'blunt' government tools aimed to reduce costs rather than improving patient care. Respondents stated that involving the patient in decision-making would help alleviate these pressures by promoting the clinical encounter as the paramount decision-point in achieving necessary care. However, CWC does not address several of the key reasons, from a physician perspective, for providing unnecessary medical care, including time pressures in the clinical encounter, uncertainty about the optimal care pathway and fear of litigation.

Conclusion: This study contributes to our understanding of the perceptions of physicians regarding the CWC campaign. Specifically, physicians believe that CWC does little to address the clinical reasons for unnecessary medical care. Ultimately, because CWC has limited impact on physician behaviour or patient expectations, it is unlikely to have a major influence on unnecessary medical care.

Keywords: Choosing Wisely; Health policy; shared decision-making; unnecessary medical care.