Choosing Wisely is an initiative of the ABIM Foundation in conjunction with Consumer Reports that began here in the United States and has spread across the world. The ABIM Foundation is part of the American Board of Internal Medicine that works toward “advancing medical professionalism to improve health care.”
Choosing Wisely’s goal is to minimize wasteful or unnecessary medical tests, treatments and procedures. The initiative encourages dialogue between patients and health care practitioners, giving patients permission to ask medical professionals questions such as:
- Do I really need to have this test, treatment or procedure?
- What are the risks?
- Are there simpler, safer options?
- What happens if I do nothing?
The goal is that treatments that are chosen are:
- Supported by evidence;
- Not duplicative of other tests or procedures already received;
- Free from harm;
- Truly necessary.
In participation with Choosing Wisely many national health organizations helped to put together lists of frequently ordered tests and procedures within specific fields that should be discussed rather than presumed necessary. The lists provide evidence-based recommendations on when it may be appropriate for different tests and procedures to be used. Consumer Reports developed materials organizing these lists for clinicians and for patients to help facilitate these much needed conversations.
For the past two years, Choosing Wisely has been a project of The Council of Medical Colleges in New Zealand. New Zealand Doctor Online gave a few examples of specific recommendations in a recent article.
- In the absence of signs of infection, pathologists are discouraged from performing surveillance urine cultures or treat bacteriuria in elderly patients.
- Epidural steroid injections are only recommended to treat lower back pain in patients who have radicular symptoms in the legs originating from the nerve roots.
- Surgical wounds should not be routinely treated with topical antibiotics.
- X-rays should not be taken for lower back pain unless there is a serious issue.
- Imaging of heads is not recommended for headaches.
- Physicians are discouraged from prescribing benzodiazepines for anxiety for long-term treatment.
- Proton pump inhibitors (PPI) are also not encouraged for long term treatment and not recommended to treat dyspepsia. When they are prescribed, doctors are encouraged to have a plan for how to reduce then end the treatment.
In fact, concern about PPI overuse has grown so much that it was the first drug selected for Deprescribing Guidelines in the Elderly, a project of a group of Canadian health care professionals. The research team offers many tools to help health care providers lower doses or discontinue use for many patients who are on these drugs that have been linked to a wide range of side effects including kidney damage.
The campaign is to be welcomed, college medical director Richard Medlicott told New Zealand Doctor Online. “There are times when [we GPs] prescribe inappropriately.”
The ABIM Foundation
New Zealand Doctor Online