More Ways To Improve Health and Reduce Harm: Choosing Wisely Phase 3

JAY SIWEK, MD, and KENNETH W. LIN, MD, MPH, Georgetown University School of Medicine, Washington, District of Columbia 

Published ahead of print January 15, 2014

The Choosing Wisely campaign is now in phase 3. If you are already familiar with it, great, because we have some new ways to help you incorporate it more effectively into your practice. But, in case you are not familiar with it, this campaign is an unprecedented effort by more than 50 medical specialty societies who have collectively contributed more than 200 key clinical recommendations to help promote best practices and avoid unnecessary and potentially harmful medical interventions.1

American Family Physician (AFP) has helped to get the word out about the Choosing Wisely campaign.2 Starting with phase 2, we crafted a table of nearly 100 recommendations of particular interest to primary care clinicians, organized by discipline.3 We also featured individual recommendations on AFP’s home page, Facebook page(, and Twitter feed.(

As of January 16, 2014, phase 3 of the Choosing Wisely campaign adds nearly 80 new primary care–relevant recommendations to the list, with more to come. We have incorporated these new recommendations into the summary table(90 page PDF).4 To make it easier to browse and access the increasing number of recommendations, you can search the recommendations relevant to primary care by key word, topic area, or sponsoring organization at

One of the challenges of the Choosing Wisely campaign is making the leap from publication to practice. Simply posting a long list of recommendations on a website is insufficient. The trick will be to turn the recommendations into action. To help readers with this, we recently introduced a new feature in AFP’s review articles. Articles with topics related to Choosing Wisely recommendations will include a table of “Best Practices” that highlights the relevant recommendations. For an example, go to We hope that this will keep these important recommendations in the forefront, and reinforce them in the context of the topic at hand. Other challenges for the campaign include enhancing the evidence base for these recommendations, and showing that following them in routine practice leads to better patient outcomes.

Previous review articles have covered Choosing Wisely recommendations related to antibiotic use in patients with upper respiratory tract infections,5 appropriate and safe use of diagnostic imaging,6 and preoperative testing before noncardiac surgery.7 Future articles and editorials will highlight Choosing Wisely recommendations and other best practices in preventive medicine, geriatrics, and patient safety, among others.

AFP is taking a multifaceted approach to making the Choosing Wisely campaign relevant and accessible to our readers by:

  • Selecting and organizing recommendations relevant to primary care.
  • Highlighting key recommendations on the AFP home page, Facebook page, and Twitter feed, and in our review articles.
  • Creating a unique and easily searchable database of all recommendations relevant to primary care on our website.

We hope that these steps will help readers put these recommendations into practice, and achieve their goals of improving care and reducing harm. If you have any other suggestions for how we can facilitate this endeavor, please e-mail us at

EDITOR'S NOTE: Dr. Siwek is editor of AFP and Dr. Lin is associate deputy editor for AFP Online.

Address correspondence to Jay Siwek, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations. 


1.    Choosing Wisely. Accessed December 23, 2013.

2.    Siwek J. Choosing Wisely: Top interventions to improve health and reduce harm, while lowering costs. Am Fam Physician. 2012;86(2):128-133.

3.    Siwek J, Lin KW. Choosing Wisely: More good clinical recommendations to improve health care quality and reduce harm. Am Fam Physician. 2013;88(3):164-168.

4.    Interventions to improve health care quality and reduce harm: consolidated items relevant to primary care from the Choosing Wisely campaign. Accessed December 23, 2013.

5.    Zoorob R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician. 2012;86(9):817-822.

6.    Crownover BK, Bepko JL. Appropriate and safe use of diagnostic imaging. Am Fam Physician. 2013;87(7):494-501.

7.    Feely MA, et al. Preoperative testing before noncardiac surgery: guidelines and recommendations. Am Fam Physician. 2013;87(6):414-418