Document Type : Commentary
Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Division of General Internal Medicine, Sinai Health, Toronto, ON, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
Low-value care drivers and interventions are often focused on a microsystem (eg, clinic or inpatient ward) or within a health system. Identification of national drivers such as payment structure and medical culture of overuse can help identify regional approaches to reducing low-value care. However, these approaches in isolation are insufficient and require additional strategies. These can include policy and payment changes and adopting shared decision-making (SDM). SDM has the potential to move medical culture away from the ‘more is better’ paternalistic and physician-centric culture to one that actively engages patients as full partners in managing their care.