Unnecessary Medical Care and Over Used Tests: The Choosing Wisely Campaign

The Choosing Wisely Campaign is an initiative which I believe I first heard about in late 2010 launched by the ACR (American College of Radiation as the Imaging Wisely Campaign) The Imagely Wisely Campaign was designed to have people aware of the fact that certain medical imaging tests such as CT exams were sometimes over used and did not always have to be used in some instances. It seems that the Choosing Wisely Campaign was launched by the ABIM Foundation which is an organization designed to advance medical professionalism to improve patient care. In April 2012 the Choosing Wisely Campaign released some lists of tests and procedures commonly done in 9 medical professions that should be questioned.  In February 2013 an additional 18 lists of tests or procedures were released. The press release is located at http://www.choosingwisely.org/wp-content/uploads/2013/02/021513_CW-Phase-II-Press-Release-FINAL.pdf

On the website of the Choosing Wisely Campaign it states

“An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.”

Consumer Reports is involved in helping to disseminate information to patients in a more readable format. On the about page of the campaign the following bullet points are presented.

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

The patient lists are located over at http://www.choosingwisely.org/doctor-patient-lists/ On this page are lists by the specialty societies currently participating which are supposed to be for doctors. There are also lists for for patients which consumer reports has helped to write along with the specialty societies. Both of these list are informative.

As an example of things provided in the list let’s take a look at the Colonscopy list for patients http://www.choosingwisely.org/doctor-patient-lists/colonoscopy/. The list states that having more than one colonscopy in a span of 5 to 10 years is not usually necessary. It also describes how colonscopy can in rare instances cause complications such as a tear in the colon and heavy bleeding. The list also provides some advice on how someone can protect themselves from colon cancer such as by changing their lifestyle and report any potential warning signs to a doctor.

As another example of things provided in the list let’s now take a look at the list for doctors from the American College of Radiology http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/. The list states that a CT should not be performed in a child with suspect appendicitis unless an ultrasound has been considered. The list also advocates against performing an x-ray in an ambulatory patient is not warranted unless something in the patient’s history or presentation suggests it.

I have previously discussed on this blog in the post How to Protect Yourself from Abusive Doctors how patients should work with their family medicine doctor to make sure tests and treatments advocated for by other doctors in other specialties is using the latest evidence. I have also addressed this in this post Tips to Prevent Medical Errors – AHRQ.

It is clear that is almost impossible for patients to accurately assess the need for and quality of care. Hence, I have also advocated for reviewing guidelines provide by the National Institute for Health and Clinical Excellence of the U.K.

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