Choosing Wisely

Tuesday, March 26, 2013

Last month 17 medical societies published a list of 90 common but often unnecessary medical procedures.  These were identified as part of the Choosing Wisely initiative (, a multi-year effort by the American Board of Internal Medicine to assist physicians in becoming better stewards of finite health care resources. Of interest to the world of IVDs is the presence of more than two dozen laboratory tests on this list. These included high volume tests such as routine use of metabolic panels, complete blood cell counts and PAP smears as well as niche tests such as serotyping for ANAs.

Choosing Wisely has as a core objective helping physicians and patients engage in conversations about the overuse of medical procedures. As a result in addition to enlisting the aid of interested medical societies to establish a menu of unnecessary procedures, Choosing Wisely is partnering with more than a dozen consumer groups including AARP, Consumer Reports, the Leapfrog Group, the National Partnership for Women & Families, Univision, and Wikipedia to prepare information about these questionable procedures for patients.  

Each medical society participating in Choosing Wisely was asked to generate a list of five high profile procedures that if properly used (or in most cases not used) could make a difference in reducing health care costs without compromising quality. Implicit although not discussed in this initiative is the value of eliminating false positive results that occur when unneeded tests are ordered and that can compromise the quality of care. Each participating society solicited potential items that were good possible candidates for a final top five list and used working groups of experts to determine the final selections. 

Most societies stuck faithfully to a top five list although the American Academy of Family Physicians added a second tier of five additional questionable items and the Society of Hospital Medicine issued five guidelines each for adult and pediatric patients. More than a dozen of the items identified demonstrated a common theme of being a test or treatment for use in asymptomatic patients. The most commonly overused item appeared to be in vivo testing, in particular misdirected imaging procedures. Additional lists from more than two dozen medical societies are expected in late 2013.

What is unique about this initiative is its patient focus and the effort to provide patients as well as physicians with information of use in decision making. In introductory comments about the Choosing Wisely campaign it is noted “it is urgent that physicians and patients work together and have conversations about wise treatment decisions. That means choosing care that is supported by evidence showing that it works for patients like them; is not duplicative of other tests or procedures already received; won’t harm them; and is truly necessary.” While it is not clear whether informed patients will actually make a difference in health care delivery, this is clearly the right standard to apply to even the most revered of old tests. Come to think of it, it is probably not a bad standard to apply to new tests as well.

Tags: Industry, Policy

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