Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
By having discussions that are informed by the doctor, but take into account what’s important to the patient too, both sides can be supported to make better decisions about care.
Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.
How choosing wisely can improve the way you receive care
A 92 year old lady was admitted to hospital with anaemia, frailty and a history of falls – She received 2 units of blood and was discharged home with care package after a few days. Some 2 months later she received an appointment for an endoscopy and colonoscopy and discussed her situation with her GP.
5 questions asked by the patient:
“The results may help to establish why you were anaemic and take steps to prevent it happening again”
"These are relatively simple but invasive tests."
“The colonoscopy in particular requires preparation and would necessitate going back into hospital to minimise risks of falling during this time. If there is no one that can stay with you overnight following the endoscopy you will have to stay in hospital again”.
“The MRI scan that you had whilst in hospital was inconclusive and other special x-rays would still require some preparation and you may be less able to tolerate them”
“That is very difficult to say. As we don’t know the reason for your anaemia we haven’t been able to suggest any remedy. However, since your discharge you have remained well, with no shortness of breath (one of the signs of anaemia) or excessive fatigue. We could keep an eye on your symptoms and blood levels (which are checked regularly anyway), prescribe an iron tablet to supplement your diet and ask your carers to remind you of the importance of eating a balanced diet and help you to prepare healthy meals”.
As she continued to make progress since Ieaving hospital, the patient decided to decline the invitation for colonoscopy and endoscopy. She remains well and has recently moved into a care home where she continues to enjoy her food and has not has any signs or symptoms of anaemia.
Downloadable prompt card can be found here.