85 Implementing tools for reduction of overdiagnosis and overtreatment in clinical practice – position papers

Abstract

Objectives The Institute for Quality in Medicine (IQM) is one of the arms of the IMA (Israeli Medical Association, representing professionally physicians in Israel). The institute publishes position papers and guidelines written by professional societies of the IMA. These documents are part of the curriculum for specialization qualification and considered as guidelines for common practice by the courts. The Israel Society for the Reduction of Overdiagnosis and Overtreatment (ISROD) was founded in 2016 under the auspices of the IMA. A position paper, written by a multidisciplinary team, was recently published by ISROD and IQM. The paper addresses all professional societies and guideline writing panels; detailing rationale and need to address overdiagnosis and overtreatment (OdX), elaborating mechanisms which lead to OdX and giving recommendations aimed at implementation of methods for reducing OdX in new clinical guidelines. We aimed to write a new position paper for the clinicians. Method A new multidisciplinary team was established……. In order to understand and relate to the different clinical contexts in which overdiagnosis happens. (as many types of clinical settings and dilemmas:) The team members come from various fields of medicine: internal medicine, emergency medicine, hematology, orthopedic, urology, general surgery, family medicine, pediatrics. Results Key points that will be included in the position paper are: Use of time as a diagnostic tool and as a strategy to prevent overdiagnosis, engaging patients in shared decision making, asking themselves and encouraging patients to ask the ‘4 questions’ about offered test and treatments (natural history, benefits, harms, alternatives), next step consideration, keeping some healthy skepticism relating to benefits of medical interventions, looking for opportunities for Quaternary Prevention in each interaction with patients, offering deprescribing and ‘undiagnosing’ when appropriate, coping with mistakes, CME, and role of the medical director. Conclusions The target of ISROD’s first position paper was guideline’s writing panels within the scientific societies. The target of the second position paper is actually each Israeli physician. We hope to provide individual doctors across medical specialties with tools to reduce overdiagnosis on a daily basis.