In an unprecedented public health initiative in an era of diminishing resources, 35 medical professional organizations have joined forces with consumer groups to promote safe and responsible utilization practices, i.e. “Choosing Wisely,” for both patients and their physicians.
Each partner medical professional organization has created or will create a list of 5 medical tests, procedures or medication indications that are not only of low value, but have also been associated with causing harm. Examples include early use of imaging for low back pain (in the absence of red flags), routine pre-operative chest x-rays, antibiotics for acute sinusitis, and screening DEXA scans in subjects at low risk for osteoporosis. There are 45 such recommendations at present but more to come in 2013 as additional medical professional organizations join the campaign.
Recognizing that demand for low value tests often originates from the public, the “Choosing Wisely” campaign has gained broad credibility in the lay media by partnering with prominent entities that enjoy loyal consumer following, such as Consumer Reports and AARP. Cogent, patient-friendly information resources from “Choosing Wisely” can be used in your practice to help patients understand why more tests or more medications aren’t always the best plan.
The unambiguous statements by professional societies recommending against certain tests in certain situations set a clear “standard of care” that should provide a comfort level to physicians when having discussions with patients and families about tests of questionable value and potential harm.
The website http://choosingwisely.org/ contains links to each of the current 45 “Choosing Wisely” recommendations, and the evidence used to develop them. It also lists the professional societies that are due to create their lists in 2013. Patient resources, such as well-written one-page discussions of the recommendations, may be downloaded from the site.