Health Care Interventions – Choosing Wisely

Lecture notes for this 8 week U3A Melbourne course.

The course outline is available here.

The timetable (based on participants feedback on possible topics) is also available.

Week 1: Topics – Improving communication between consumers / patients and their health care providers. Assessing the risks, benefits and costs of interventions.

Week 2: Topics – Screening to detect cancer, e.g. Bowel (Faecal occult blood test, Colonoscopy), Prostate (PSA test), Breast (mammography).

Week 3: Topics – Cancer treatment, (surgery, chemotherapy, radiotherapy, etc.).

I’ve also posted a new decision aid for breast cancer screening devised by colleagues at the University of Sydney, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED). They have recently reported a randomised controlled trial of its use to support informed decision making.

See also an article in “The Age”, May 6, 2015, “Breast cancer screening harming hundreds of women a year: Surgeon“.

Week 4: Topic – Intensive care (cardiopulmonary resuscitation, etc).

In addition, Case 1 and Case 2 used for group discussion are also available for download.

Week 5: Topics (Dr Rodney Syme, Dying with Dignity) –  Medical treatment Act 1988; Enduring Power of Attorney (Medical Treatment); Refusal of medical treatment; Advance Healthcare Directive; Palliative care (Victoria).

Additional resources (week 5):

  • MyValues: a set of specially constructed statements designed to help you identify, consider and communicate your wishes about the medical treatment you would want in the later stages of life (a not-for-profit service operated by Barwon Health, funded by The Victorian Department of Health).
  • An example of a completed Advance Healthcare Directive (from Dying with Dignity).
  • Video (Ted Talk): Prepare for a good end of life.

Week 6: Topics (Dr Rodney Syme, Dying with Dignity) – Dementia and end of life decision making. Resources mentioned:

Additional resources (week 6):

Week 7: Topics – Unnecessary antibiotics (minimising antibiotic resistance), Polypharmacy (multiple medication) and deprescribing, Antipsychotics in dementia, Home medicine reviews, Consumer Medicine Information (CMI), Shared electronic health record.

Also, Ray suggested the following resources:

  • The Victorian Office of the Public Advocate: Take Control – a kit for making powers of attorney and guardianship. It provides clear information about powers of attorney and guardianship, step by step instructions, and a complete set of all the forms you may need.
  • The Guardian Weekly UK news 22.05.15: Doctors move to end culture of giving ‘too much medicine’.

See also:

Week 8:  Keeping Healthy -Topics:

  • Immunisation: Influenza, Pneumococcal and Herpes zoster vaccine; also diphtheria-tetanus-whooping cough booster shots.
  • Minimising the risk of: Coronary heart disease, heart attacks and stroke, Cancer, Falls and fractures, Depression and Dementia.
  • Coping with:Osteoarthritis.
  • Healthy eating and exercise; Motivation.
  • Conclusion.



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About Dr Ken Harvey

Public Health Physician, Medical activitist
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