Choosing Wisely: More Good Clinical Recommendations to Improve Health Care Quality and Reduce Harm
JAY SIWEK, MD, Georgetown University Medical Center, Washington, District of Columbia
KENNETH W. LIN, MD, Georgetown University School of Medicine, Washington, District of Columbia
Published ahead of print March 19, 2013
The Choosing Wisely campaign provides key clinical recommendations for physicians and patients that promote best practices and help avoid unnecessary medical interventions. This campaign is sponsored by the American Board of Internal Medicine Foundation, and initially nine medical specialty societies participated by providing a list of their top five recommendations. We previously published the lists from the three primary care specialty societies in American Family Physician (AFP),1 and maintain the lists on our website. Now, another 16 medical specialty organizations have joined the campaign, with more to come. In addition, Consumer Reports, AARP, and a dozen other consumer-oriented groups have partnered with the Choosing Wisely campaign to help provide information and resources to patients on making wise decisions about health care. This is an unprecedented collaborative project in the house of medicine. Hopefully, it will have far-reaching implications for improving practice and patient outcomes, lowering costs, and reducing harm.
Although the Choosing Wisely campaign is calling long overdue attention to the use of unnecessary diagnostic tests and treatments, this is hardly a new problem. A review of 172 studies performed between 1980 and 2009 found that a large proportion of physicians provide inappropriate interventions, such as antibiotics for upper respiratory tract infections, and perform inappropriate tests, such as Papanicolaou smears in women without a cervix, prostate-specific antigen testing in elderly men, and imaging for acute low back pain.2 Rather than improving over time, rates of unnecessary services have stayed the same or worsened. Compared with 10 years ago, physicians today are equally likely to perform a complete blood count, electrocardiography, and chest radiography as part of routine health maintenance examinations, and more likely to screen men 75 years or older for prostate cancer.3 Not only do these tests offer no health benefits and expose patients to harm, but even normal results don't make patients feel better.4
In the accompanying table(30 page PDF), we have included the recommendations from the Choosing Wisely campaign that we consider especially relevant to primary care, and have organized them by discipline/body system. With nearly 100 recommendations on the list, and more to come, we thought this display would help readers more easily find these useful practice pointers. The complete list of recommendations relevant to primary care, including the rationale, comments, and references, will be maintained here. To help highlight these valuable tips, we also will be featuring them on Twitter(twitter.com), Facebook(www.facebook.com), and the AFP home page.
More information about the Choosing Wisely campaign is available at http://choosingwisely.org(choosingwisely.org).
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 firstname.lastname@example.org. Reprints are not available from the authors.
Author disclosure: No relevant financial affiliations.
1. Siwek J. Choosing Wisely: Top interventions to improve health and reduce harm, while lowering costs. Am Fam Physician. 2012;86(2):128-133.
2. Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S. Overuse of health care services in the United States: an understudied problem. Arch Intern Med. 2012;172(2):171-178.
3.Kale MS, Bishop TF, Federman AD, Keyhani S. Trends in the overuse of ambulatory health care services in the United States. JAMA Intern Med. 2013;173(2):142-148.
4.Rolfe A, Burton C. Reassurance after diagnostic testing with a low pretest probability of series disease: systematic review and meta-analysis [published online ahead of print February 25, 2013]. JAMA Intern Med. http://archinte.jamanetwork.com/article.aspx?articleid=1656539(archinte.jamanetwork.com). Accessed March 21, 2013.