Importance of good patient-clinician communication to be emphasised at Choosing Wisely forum

Kaushiki Roy will be one of the consumer voices at the Choosing Wisely forum, Continuing the Conversation. The forum will take place at Te Wharewaka o Poneke in Wellington on Friday 10 May, 2019.

The Choosing Wisely campaign encourages health professionals to talk with patients about unnecessary tests, treatments and procedures; and patients to discuss with their health professional whether they really need a particular intervention. Registrations are open for the forum.

Kaushiki is a singer and writer who works full-time in a busy project and portfolio office in Wellington. She migrated to New Zealand in 2007 and lives on her own in an inner-city apartment. She will tell the Choosing Wisely forum about the difficult medical decisions she is having to make, the importance of good communication between patients and clinicians, and emphasise the need for patients to be seen as a whole person.

'After a planned hysterectomy in 2016, the pain I had would not go away and I had a number of tests,' she says. 'I was finally diagnosed with Cushing’s disease, a rare condition linked to having too much cortisol in your body.” Symptoms of Cushing’s disease include weight gain, thinning skin and fatigue. Kaushiki had also been recently diagnosed with glaucoma.

'Since being diagnosed, I have had two surgeries and have received advice about further surgery I may need to have. More surgery is likely to seriously impact my quality of life, however uncured Cushing’s is not an option. So it is extremely difficult for me to know what to do.'

As Cushing’s is a disease impacting multiple systems, one of the key challenges Kaushiki has faced is aligning the different medical specialties – neurosurgery, endocrinology, ophthalmology and general or internal medicine.

'I ask my doctors, ‘please see me as a whole person’.'

Kaushiki ensures her specialists communicate with one another and cross-check treatment plans – but this is not always an easy process. Getting through each day is a challenge. Her medication has many unpleasant side effects and she worries about losing her vision and independence.

'I think hard about each decision I make about my health and wellbeing, and look at all the options. I need to feel reassured that any decision to have surgery or medication is the right one for me, and not just because these treatments are on the prescribed pathway.'

She says having medical professionals discuss the pros and cons of tests and treatments with their patients and allowing them time to come to their decisions is an essential part of clinical communications and effective care.

'It is so important clinicians talk across disciplines, so the patient can align their care and feel seen as a whole person.'

The Choosing Wisely forum provides an opportunity for health professionals to learn more about how to develop and extend their Choosing Wisely work.

Forum speakers include:

• Kirsten McCaffey, Director of Research at the Sydney School of Public Health and Director of the Sydney Health Literacy Lab. Kirsten has an international reputation in shared decision making, health literacy and the assessment of psychosocial outcomes
• Associate Prof Sue Crengle from Otago University’s Department of Preventive and Social Medicine, who will discuss Choosing Wisely and equity
• Dr Robyn Lindner from Choosing Wisely in Australia, who will discuss successfully implementing the campaign, and evaluation.

As with last year’s forum, there will be commentary from consumers on all sessions. There will also be a repeat of last year’s popular special interest groups, including Choosing Wisely 101 for those just learning about this work.

Depending on interest, other workshops will cover:

• Spreading the message
• Choosing Wisely and allied health
• Choosing Wisely working in nursing
• Choosing Wisely and medical education
• Choosing Wisely and pharmacy
• Choosing Wisely in general practice
• Choosing Wisely and medico legal issues.

The Choosing Wisely campaign is gaining momentum in New Zealand. Seventeen district health boards are involved in Choosing Wisely work and it is supported by a number of PHOs and GP practices. Thirty-one medical colleges, specialty societies and health practitioners’ associations are now linked to the campaign. Over 154 lists of tests, treatments and procedures that should be questioned have been developed, along with 45 patient resources.