Adina Weinerman
1, Christine Soong
2,3,4* 
2 Division of General Internal Medicine, Sinai Health, Toronto, ON, Canada.
1 Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
4 Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada.
Abstract
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.