Don’t recommend a test, a treatment or a procedure that will not change the patient clinical course; do not hesitate to ask your tutor for clarification if you believe that those tests, treatment or procedures are not necessary and always opt for less invasive options.
The administration of tests, treatment or procedures might not change the patient management plan for many reasons. In some cases, the pre-test probability of a patient for a certain condition is low and further testing might not be necessary (e.g. brest cancer screaning in young women with low risk of malignancy). Another example could be preoperatory testing before a low risk surgical procedure in which the risk for complications is low. Furthermore, sometimes the patient management would not change after the results of the test that we want to order because of age and/or comorbidities. When possible, residents should always rely on evidence-based guidelines to lead their choice on appropriate testing and treatment. One must always consider that tests, treatment and procedures which are not necessary may cause harm to patients, both directly or indirectly (false positives and overdiagnosis), and have an impact on the ecosystem.
Unfortunately, in some learning environment the established hierarchy between tutors and residents makes it hard for residents to feel comfortable and manifest their doubts. Tutors should always encourage residents to feel free to ask whether tests, treatment and procedures are really necessary without fearing repercussions. Residency should be an environment in which resitents can feel comfortable to ask questions.
1. Choosing Wisely Canada. Six Things Medical Students and Trainees Should Question - [Internet] – 2015 https://choosingwiselycanada.org/wp-content/uploads/2017/04/Medical-students-and-trainees.pdf
2. Choosing Wisely Canada. Five Things Medical Residents and Patients Should Question - [Internet] – 2017 https://choosingwiselycanada.org/recommendation/residents/
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.