Must-Read Choosing Wisely Articles of 2015

Choosing Wisely® continued to expand in 2015, with 17 medical specialty societies releasing new lists of “Things Physicians and Patients Should Question.” The campaign also continues to influence scholarly journal articles and mainstream media coverage about waste and overuse in health care, with more than 3,700 media mentions and nearly 110 journal articles in 2015. As the new year begins, the ABIM Foundation staff continues its tradition of looking back at Choosing Wisely coverage from 2015 and selecting the “Top 5” must-read articles for patients and physicians.

For Patients

CBS News: Do You Really Need That MRI?

This overview of the Choosing Wisely campaign and its work to date features an interview with Richard J. Baron, President and CEO of the ABIM Foundation, as well as other physicians from the fields of neurology, pulmonology, critical care and sleep medicine speaking about reducing unnecessary tests and procedures. Dr. Baron explains that the goal behind Choosing Wisely is to help physicians and patients make more informed decisions about medical interventions, based on medical evidence. He said that physicians and patients might think that “more is always better” when it comes to health care.

The New York Times: Some Older Patients Are Treated Not Wisely, but Too Much

This piece centers around researchers at the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System, who coined the term “deintensification” for an evidence-based approach to treating older adults with diabetes and other health issues less aggressively. The article mentions the American Geriatrics Society’s Choosing Wisely recommendation about a 7 to 7.5 percent A1c target (measure of recent blood glucose control) as a reasonable goal for healthy older adults.

The Washington Post: A Nurse with Fatal Breast Cancer Says End-of-Life Discussions Saved Her Life

Amy Berman wrote about her battle with breast cancer and end-of-life decisions. She shared that when her cancer spread to her ribs recently, she could have opted for 10 to 20 doses of radiation to ease her pain. But she noted the Choosing Wisely recommendation for fewer doses. Instead, she discussed a single, large dose of radiation with her palliative care provider and ultimately went with that option. The result: “It worked like a charm,” Berman wrote.” I felt better, avoided the terrible side effects of repeated radiation, got immediate relief and avoided paying for all the unnecessary doses of radiation.”

Parents magazine: Medical Interventions Your Kid (Probably) Doesn’t Need

Parents was one of many outlets that featured stories about the American Academy of Pediatrics’ (AAP) top five unnecessary tests and treatments identified in newborn medicine, published in Pediatrics in July. Then, in September, the magazine ran a feature about interventions kids might not need, which was authored by a physician. It mentions six tests and procedures identified on Choosing Wisely lists as things parents and clinicians should question – plus one more common practice to think about when treating children with fevers.

Nebraska World-Herald: Doctors’ Campaign Promotes a New Normal: Fewer Tests and Scans

This in-depth look at Choosing Wisely includes interviews with physicians discussing several specialty society recommendations as well as information about how the campaign has been having an impact in Nebraska. The package includes several resources for patients, including a history of the Choosing Wisely campaign, questions to ask if their doctor suggests certain tests or procedures, a checklist to take on appointments, and pointers about risks from repeated X-rays. The outlet also followed up with an opinion piece about the campaign.

For Physicians (some articles may require registration or subscription)

Family Practice Management: How to Help Your Patients Choose Wisely

Opening with three clinical scenarios in which physicians often prescribe unneeded treatments, this piece focuses on Choosing Wisely as a way for “patients and physicians to accept that health does not always improve when more care is delivered.” It continues by offering three key strategies on how physicians can incorporate Choosing Wisely into practice: Know the evidence, help patients make informed decisions and build (and lead) the system. It points to Crystal Run Healthcare as a system that has adopted Choosing Wisely and “used peer teaching, clinical decision support, and feedback to reduce overuse of imaging for acute low back pain, antibiotics for sinusitis, DEXA screening, and electrocardiograms (ECGs) in asymptomatic patients.”

Modern Healthcare: Five Ways to Maximize Clinical Support Tools

Focusing on clinical decision support (CDS) tools, this story includes an interview with Scott Weingarten, MD, who led work to implement a CDS that included dozens of Choosing Wisely recommendations at Cedars-Sinai Medical Center. He advises that the best way to share CDS is by programming it into the EHR, and that CDS “should be evidence-based, accepted by clinicians, clinically meaningful, have low false-positive rates to prevent ‘alert fatigue’ and a measurable positive impact on patient care.”

The Hospitalist: 10 Things Geriatricians Want Hospitalists to Know

Recognizing that the American population is aging, The Hospitalist surveyed geriatricians and listed their advice on treating older patients. “Follow the Choosing Wisely guidelines set forth by the American Geriatrics Society” is the third item on the list as “an excellent reference for hospitalists treating the elderly.” This article echoes a theme we’ve seen throughout 2015: Societies such as the Academy of Neurology (AAN) and the American Society of Hematology (ASH) are exploring Choosing Wisely recommendations from other disciplines.

The New England Journal of Medicine: Improving Value in Health Care — Against the Annual Physical

This perspective piece points to many examples of evidence that the annual physical is not needed, including the Society of General Internal Medicine’s Choosing Wisely recommendation against annual preventive examinations in asymptomatic patients. But, the authors point out, “past calls to simply eliminate annual physicals have proven ineffective in changing clinical practice” since “about one third of U.S. adults receive an annual physical … in any given year.” They offer three steps to foster change, including creating a new type of visit to establish relationships between doctors and patients, actively tracking that patients’ preventive care services are up to date, and not using annual physicals as a measure of health care quality.

MedPage Today: Understanding Healthcare Costs: Meaningful Steps Going Forward

This series looks at ways doctors and patients can have a meaningful conversation about costs of healthcare. Several clinicians are asked to provide advice and possible steps forward, including September Wallingford, RN, MSN, director of operations for Costs of Care, who mentions Choosing Wisely as “a great resource to empower patients to have a conversation with their provider to make sure that the ‘right care is delivered at the right time.’”