The Choosing Wisely campaign is now five years old.
It’s a birthday we should all be celebrating.
Launched in 2012 by the American Board of Internal Medicine Foundation in collaboration with Consumer Reports, the campaign is designed to help physicians and patients choose medical care that is (in the words of the campaign):
- supported by evidence
- not duplicative of other tests or procedures already received
- free from harm
- truly necessary
In other words, the campaign’s purpose is to help all of us make more rational, evidence-based and, ultimately, safer decisions about our health care.
That means not being afraid to ask your doctor pointed questions: Do you really need a CT scan for a headache? Or a bone density scan for osteoporosis? Or antibiotics for sinusitis? Or a blood test for vitamin D?
Over the past five years, the Choosing Wisely campaign has compiled detailed but easily accessible resources to help patients ask these and other questions about hundreds of medical tests and treatments that are often either overused or that provide little benefit — and in some cases cause harm. The recommendations come from several dozen medical societies in the United States and around the world. (The campaign has gone global.)
Signs of progress
Choosing Wisely has been criticized, mostly for not going far enough with its recommendations. But the campaign has had an impact, although it’s too early to know how much of an impact, says Alan Cassels, a drug policy researcher at the University of Victoria in Canada, in an article published this week on the Minnesota-based HealthNewsReview website.
“It is certainly being studied to see where it may be impacting patient care,” writes Cassels. A Canadian survey, he points out, found that about one in 10 patients in that country is aware of the campaign, and another report found that 62 percent of Canadians “feel there is too much unnecessary health care, such as giving routine mammograms to average-risk women in their 40s.”
Other signs of the campaign’s impact, says Cassels, include the international Preventing Overdiagnosis Conference, which will be convening for the fifth time later this year, as well as changes at the “grassroots” level. To illustrate those latter changes, Cassels uses the example of what happened when Group Health clinicians in Seattle consulted with Choosing Wisely:
They sought to help physicians understand that patient requests about a test or drug simply may be an attempt to get additional information — and shouldn’t be treated as if the patient wants the test or drug. It was described this way: “Group Health first helped physicians and other providers change their perspective on the situation. For example, they asked doctors to look at patient requests for unnecessary treatment as partially informed inquiries, not a demand for services. Clinicians were encouraged to listen and show empathy to the patient, acknowledge symptoms and ask what could be done to manage discomfort. Then the physician provided better information and educated the patient.”
Five important questions
“In the end,” writes Cassels, “Choosing Wisely is all about asking better, more vital questions.”
With that in mind, here are the five basic questions that the campaigns says all of us should ask our doctors before we undergo any test or treatment:
1. Do I really need this test or procedure?
2. What are the risks and side effects?
3. Are there simpler, safer options?
4. What happens if I don’t do anything?
5. How much does it cost, and will my insurance pay for it?
For more information: You’ll find the Choosing Wisely lists of tests and treatments on the campaign’s website. I recommend bookmarking the site, so you have it handy the next time you have an appointment with a doctor.