Avoid Overtreatment

by Stefani Daniels, Founder & Principal Consultant
Published on Jun 28, 2016

The explicit goal of Choosing Wisely is to identify and promote care that is (1) supported by evidence; (2) not duplicative of other tests or procedures already received; (3) free from harm; and (4) truly necessary. In response to this challenge, medical specialty societies asked their members to “choose wisely” by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed. The resulting lists of “Things Providers and Patients Should Question” was designed to spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

Work spearheaded by the American Hospital Association and the American Board of Internal Medicine Foundation (ABIM) aims to draw on the prominent role of hospital executives and medical leaders in health care to help limit physicians from recommending or providing care that is more than a patient needs or is outright unnecessary.  

Separately, the ABIM Foundation announced it would be allocating $4.2 million in grant money from the Robert Wood Johnson Foundation to support the engagement of hospital leaders and medical groups in its Choosing Wisely campaign. To date, more than 70 separate medical societies have released recommendations with the intention of facilitating wise decisions about the most appropriate care based on a patients’ individual situation. In addition, Consumer Reports has joined the campaign and offers resources for consumers and physicians to engage in these important conversations about the overuse or misuse of medical tests and procedures that provide little benefit and in some cases harm. The campaign's primary focus is to get medical societies to create lists of procedures that have the potential to be used inappropriately, and encouraging discussion between providers and patients about how and when to use them.   The goals of the campaign were and still are to foster discussions around avoiding wasteful health care, and to shift away from the polarizing language of “rationing” and “death panels.” As evidenced in the increased number of clinical articles, continued coverage in traditional and social media, educational sessions on overuse at clinical and policy conferences, and the expansion of Choosing Wisely campaigns internationally, the conversations are indeed happening. But are conversations enough?

Choosing Wisely has been criticized for focusing on conversations instead of measures and implementation. It has also been criticized by some who said the content of the lists of unnecessary tests and procedures compiled by various specialties do not address the more challenging areas of overuse. These are valid concerns.

The Choosing Wisely campaign was designed to raise the profile of the issues of waste and overtreatment in health care. Behavioral change won’t come from conversations alone. We’ll need to look to tried-and-true quality management approaches that go beyond education to include performance improvement initiatives and system changes  But a public education campaign—which Choosing Wisely has always been—is a spark, a spark that hopefully lights a fire. What more should the hospital care management community be doing? We raise these ideas and calls to action for everyone engaged in health care.