On April 4, 2012, the ABIM Foundation formally launched the Choosing Wisely® campaign with nine trailblazing society partners releasing lists of “Five Things Physicians and Patients Should Question.” Nearly three years later the campaign continues to grow with 70 societies joining in the effort. In 2014 alone, new lists were released by 24 organizations and expanded to include other members of the care team such as the American Physical Therapy Association and the American Academy of Nursing.
This past year was significant for the campaign because conversations inspired by Choosing Wisely around reducing waste and overuse permeated not only the health care community and academic publications but mainstream media as well. By our count, there have been more than 4,200 media mentions of the campaign and society recommendations and nearly 90 journal articles on the Choosing Wisely campaign in 2014 alone.
In the spirit of Choosing Wisely, the following represent the ABIM Foundation staff picks for the “Top 5” must-read articles from 2014 for patients and physicians.
- Harvard Business Review: How to Stop the Overconsumption of Health Care
Dr. Eve Kerr and John Ayanian explore the drivers of overuse in the United States health care system, arguing that while many decisions are informed by clinical evidence and expertise, too often they are made out of habit, hunches or misaligned economic incentives. The authors call for reform in how care is delivered, and laud Choosing Wisely for “helping transform the culture of health care.”
- The New York Times Old Age Blog: Geriatricians Question Five Common Tests
“It tells you something about American health care that scores of medical societies have joined a major campaign aimed at telling patients and doctors what not to do,” writes Paula Span in this piece about a second list of tests and procedures to question from the American Geriatrics Society.
- The Washington Post: Doctors Think Others Prescribe Unnecessary Care
A survey commissioned by the ABIM Foundation found that three out of four physicians believe their peers prescribe unnecessary tests or procedures weekly. It also found that nearly half of physicians said that if faced with an insistent patient, they would advise against it but would ultimately order a test or procedure even if they did not believe it to be necessary. “I think we’re afraid of not being liked,” said Dr. Donald Ford, a Vice President at Hillcrest Hospital, part of the Cleveland Clinic Health System and located in Mayfield Heights, Ohio. “We want to be the hero to the patient.”
“Old habits die hard,” writes Lisa Zamosky in this piece that highlights the challenges physicians and patients face in identifying which tests and treatments they truly need. Some of the situations patients may more commonly face – including the overprescribing of antibiotics and ordering of unneccessary EKGs and PSA tests – are referenced, and readers are encouraged to visit the Choosing Wisely website, which is “packed with information for patients and doctors that may amaze you.”
- Seattle Times: Over-prescribed: More health care isn’t always better
“I consider myself to be a relatively healthy person. I don’t smoke; I exercise; I eat my vegetables,” writes Maureen O’Hagan, just before sharing a litany of medical tests and treatments she’s received over the years that she says came with not just financial costs, but carried potential for unnecessary harm. Highlighted in this article is the work of the WashingtonStateChoosing Wisely Task Force, which published the first report in the nation measuring utilization of nine different Choosing Wisely recommendations in the state.
For Physicians (some articles may require registration or subscription)
The title alone is reason to include this article on the list, which discussed a research study showing that prescriptions for hypofractionation, a more convenient, cheaper and shorter course of treatment for breast cancer patients, increased after being promoted through ASTRO’s involvement in Choosing Wisely. While the authors acknowledge the sample size limits its authority, they are encouraged by the results.
- American Journal of Roentgenology: The Choosing Wisely Initiative of the American Board of Internal Medicine Foundation: What Will Its Impact Be on Radiology Practice?
Examining Choosing Wisely from the perspective of a radiologist, Drs. Vijay Rao and David Levin suggest that radiologists need to be more engaged in providing more value-based care, even if it means fewer referrals. “This culture shift will likely lead to fewer referrals to imaging facilities for examinations they frequently performed in the past, which might be seen as bad for radiologists. However, there is no question that minimizing the use of these examinations is the right thing for patients and for our health care system,” Rao and Levin write.
- New England Journal of Medicine: Choosing Wisely — The Politics and Economics of Labeling Low-Value Services:
In one of the most talked about Choosing Wisely journal articles of the year, the authors claimed that “participating societies generally named other specialties as low-value” and “more numerous and more courageous lists should be developed and published.” While the authors were generally supportive of the campaign’s ideals, this type of critical conversation is a hallmark of Choosing Wisely. The ABIM Foundation responded to the authors in a related blog post.
- Journal of Oncology Practice: Getting from Choosing Wisely to Spending Wisely
J. Russel Hoverman, MD, PhD writes of the Choosing Wisely lists, “The mandate is to reinforce the discussions physicians have with patients and educate patients as to what is best for them based on the best science. But it is fair to ask if something more profound is occurring.” He then examines the importance and difficulty of measuring the impact of the Choosing Wisely recommendations using ASCO’s 10 recommendations as examples. He concludes, “The response of professional societies to the Choosing Wisely campaign is both dismaying and encouraging: dismaying in that there have been so many circumstances where costs were not justified by evidence (we have met the enemy and he is us), and encouraging in that the professional societies have responded so vigorously.”
- Academic Medicine: Engaging Physicians and Consumers in Conversations About Treatment Overuse and Waste: A Short History of the Choosing Wisely Campaign
This piece covers the engaging history of the Choosing Wisely campaign and examines a number of factors responsible for its success. “Everyone agrees that patient welfare must come first. That welfare is currently threatened by the unpredictable financial future of our health care system. But if patients and physicians choose wisely, trusting each other as they do so, our shared future may improve,” the authors write.
Full disclosure: ABIM Foundation and Consumer Reports staff members authored this article.