The “Choosing Wisely: Things We Do for No Reason” series started in 2012 at the Society of Hospital Medicine annual meeting. Dr. Daniel Brotman, the annual meeting director for SHM, invited Dr. Leonard Feldman to give a talk originally entitled “Non-Evidence-Based Medicine: Things We Do for No Reason.” After receiving positive feedback on the 2012 presentation, Feldman continued to present new “Things We Do for No Reason” topics annually.
In between the meetings, Feldman regularly received ideas about future topics from colleagues across the country, suggesting that the “Things We Do for No Reason concept” had resonated with hospitalists. Given the interest that the presentations generated, Feldman approached Dr. Andrew Auerbach, Editor-in-Chief of the Journal of Hospital Medicine, with the idea of creating a journal series to further the high-value care conversation.
The series started in 2015 with an editorial by Feldman and quickly became the most popular offering in the Journal of Hospital Medicine. Here, Feldman and his co deputy editor, Dr. Anthony Breu, reflect on what the series has meant to them and to readers.
“Since our start, we have published over 40 different articles in the series, including two rebutting editorials. Though we intended to only published articles quarterly, the overwhelming amount of interest made us stray from original plan.
We have tried to expand beyond the Choosing Wisely recommendations. The topics are the low-hanging fruit of low-value care as they include practices in medicine that continue to occur frequently despite evidence that they do not help, and may harm, patients. These are practices that internists, family practitioners, and pediatricians hand down from generation to generation of learners. We continue to practice this way because that is how we have always done it (or at least it seems like we have) or because our original understanding supportive the practice.
Our hope is that these many examples of Things We Do for No Reason encourage learners and practicing attendings to question why they are doing what they are doing. Topics have ranged from thrombophilia testing in the inpatient setting to prescribing antibiotics that cover listeria in neonates with fevers and treating patients suffering from constipation with docusate.
Understanding that low-value care is not just about avoiding the things we should not be doing, but also includes the practices we omit, we have started to highlight practices we fail to do. For instance, we fail to question if a reported penicillin allergy is real. As Dr. Renee Kleris eloquently wrote in our March 2019 article, not questioning can lead to significant harms. We have tried to make the series relevant to those who care for children and adults, and we have not shied away from covering controversial topics. The rebuttal editorials are testament to that.”
In 2017, Breu took over the annual presentation from Feldman at the Society of Hospital Medicine meeting, and in 2018 he joined Feldman as the co-editor of the “Things We Do for No Reason” series. As co-editor, Breu has incorporated threaded tweets (“Tweetorials”) to complement each publication in the series.
Using polls, graphics and hyperlinks, the Tweetorials generally include 10-15 tweets highlighting the key points of the topic and have greatly increased the reach of the series. As one example, the Tweetorial covering the treatment of hypertensive urgency garnered over 45,000 impressions with a total engagement over 3,700 people.
The Journal of Hospital Medicine, Feldman and Breu remain confident that the imperative to practice high-value care will ensure that the reach and impact of the series will continue to grow. They are always looking for more ideas, and can be contacted through their email at firstname.lastname@example.org.