Thread by @Drug_Evidence

THREAD: Ten Commandments for patient-centred treatment 🧾

1/11 A TI Tweetorial on the “Ten Commandments’ of the New Therapeutics

Revisiting timely words of medical wisdom from the BMJ
bjgp.org/content/65/639…

#MedEd #prescribing

2/11 1st Commandment:

Thou shalt have no aim except to HELP patients, according to the GOALS they wish to achieve 👩‍⚕️
bjgp.org/content/65/639…

Shared decision-making lessons from @LessIsMoreMed: lessismoremedicine.com/hands-on

#MedEd #TreatmentGoals

3/11 2nd Commandment:

Thou shalt always seek knowledge of BENEFITS, HARMS, COSTS of treatment & share this knowledge at all times
bjgp.org/content/65/639…

Try these:
ti.ubc.ca/therapeutics-l…
@thenntgroup
medi-mouse.com
pac.bluecross.ca/pharmacycompass

#MedEd #ptsafety

4/11 3rd Commandment

Thou shalt, if all else fails or if the evidence is lacking, happily consider WATCHFUL WAITING as an appropriate course of action
bjgp.org/content/65/639…

See:
en.wikipedia.org/wiki/Watchful_…
pubmed.ncbi.nlm.nih.gov/27536798

#MedEd #prescribing

5/11 4th Commandment:

Thou shalt honour balanced sources of knowledge, but thou shalt keep thyself from all who may seek to deceive thee:
bjgp.org/content/65/639…

Prescriber interaction with industry and impacts:
bit.ly/3fWphXq

#MedEd #drugmarketing #prescribing

6/11 5th Commandment

Thou shalt treat according to level of risk, not to level of risk factor bjgp.org/content/65/639…

Idolatry of the surrogate
doi.org/10.1136/bmj.d7…

Limitations & potential hazards of surrogate markers ti.ubc.ca/letter92

#MedEd #SurrogateMarkers

7/11 6th Commandment:

Thou shalt not bow down to treatment 🎯 designed by committees, for these are but graven images bjgp.org/content/65/639…

Problems with conflicts of interest in guideline committees: bmjopen.bmj.com/content/9/2/e0…

#MedEd #guidelines #TreatmentTargets

8/11 7th Commandment:

Honour thy older patients, for although they often have the highest RISK, they may also have the highest risk of HARM from treatment

bjgp.org/content/65/639…

#MedEd #prescribing #elderly #ptsafety

9/11 8th Commandment:

Thou shalt 🛑 any tx that is not of clear benefit and regularly REASSESS the need for all treatments & tests bjgp.org/content/65/639…

Think #deprescribing:

bcmj.org/articles/drug-… @BCMedicalJrnl

ti.ubc.ca/letter90

#MedEd #polypharmacy

10/11 9th Commandment:

Thou shalt diligently try to find the best treatment for the individual, because DIFFERENT treatments work for DIFFERENT people 👨👩🏾‍🦱
bjgp.org/content/65/639…

Titrating doses: Minimise to Maximise 💊ti.ubc.ca/letter10

#MedEd #prescribing

11/11 10th Commandment

Thou shalt seek to use as few drugs as possible bjgp.org/content/65/639…

B4 #prescribing, consider effectiveness of non-drug interventions

Don't use 💊 as a shortcut because alternatives might take more time to explain or be harder to access

#MedEd

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