Journal Article

Choosing wisely 10 years later: reflection and looking ahead

Correia, Luis, Levinson, Wendy, Ellen, Moriah

2024

Overview

Correspondence to Dr Moriah Ellen, Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, 8400711, Israel; [e-mail] Ellen and colleagues argue that expanding the geographical and professional reach and thematic scope of choosing wisely could help achieve greater impact Choosing wisely (CW) is a campaign for healthcare professionals and patients to engage in conversations about unnecessary tests, treatments and procedures, and to help them make smart and effective choices to ensure high-quality care.1 Through this partnership, national organisations representing medical specialists identify tests or procedures commonly used in their field whose necessity should be questioned and discussed. A successful decade has passed since CW recommendation ‘five things to question’ lists were first published in the USA in 2012 based on the input of 9 different medical societies.2 3 The past decade has included a plethora of accomplishments, including the internationalisation and local adaptation of the campaign in countries such as Canada, the Netherlands, Australia, New Zealand, Israel and the UK, as well as the successful implementation of various recommendations, for example, reducing unnecessary blood chemistry testing in the emergency department or reducing unnecessary antibiotic prescribing and antipsychotics use.4 5 Potential harms of overuse for patients include overdiagnosis,6 overtreatment,7 antibiotic resistance8 and radiation exposure.9 Up until now, the emphasis of many campaigns has been to raise awareness about overuse as an important problem to address. [...]expanding CW a step beyond a clinical approach focused on the individual encounter between clinicians and patients to address the systemic causes of overuse. Hospital systems are controlled by the administration and other systems may be controlled by payers or governments, for example, ordering systems for lab tests and financial incentives for interventions.21 Some overuse is ‘baked in’ to the system and individual clinicians have little or no influence on these; changes need to happen at the system level that is often controlled by payers in a top-down fashion.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Analysis / Antibiotics / Collaboration / costs and cost analysis / Decision making / delivery of health care / environment and public health / global health / Health care access / health services research / High income / Industrialized nations / Medical personnel / Patient education / Professionals / Public health / Radiation / Stakeholders / Surgeons