Choosing Wisely campaign to reduce the harms of too much medicine comes to the UK

A US initiative to get doctors to stop using interventions with no benefit, “Choosing Wisely”, is being launched in the UK this week.

The Academy of Medical Royal Colleges is launching the Choosing Wisely programme in partnership with specialty organisations, including the British Medical Journal (The BMJ), to help tackle the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care. At its heart, Choosing Wisely is about encouraging both doctors and patients to have a conversation about the value of treatments.

The publication of a paper in The BMJ this week marks the start of the initiative. The paper sets out the aims of the Choosing Wisely project and explains why doing nothing can often be the best approach.

Unnecessary care occurs when people are diagnosed and treated for conditions that will never cause them harm, and there is growing evidence that many people are overdiagnosed and overtreated for a wide range of conditions such as prostate and thyroid cancers, asthma, and chronic kidney disease.

As part of the initiative, participating organisations will be asked to identify five tests or procedures commonly used in their field, whose necessity should be questioned and whose risks and benefits should be discussed with patients before using them. When those results are collated they will be analysed, assessed for accuracy and then published in the autumn of 2015. After that the Academy of Medical Royal Colleges will launch a major public campaign to make doctors and patients aware of the list.

Choosing Wisely initiatives already adopted in many countries across the globe

So far, more than 60 US specialist societies have joined the Choosing Wisely initiative. It has also been adopted by other countries, including Australia, Germany, Italy, Japan, Netherlands and Switzerland – a clear sign that wasteful medical practices are a problem for all health systems. According to the authors of paper published in The BMJ, a culture of “more is better,” where the onus is on doctors to “do something” at each consultation has bred unbalanced decision making. This culture threatens the sustainability of high quality healthcare and stems from defensive medicine, patient pressures, biased reporting in medical journals, commercial conflicts of interest, and lack of understanding of health statistics and risk.

Rather than focusing on a system of payment by results – which encourages doctors and hospitals to do more – authors of the study published in The BMJ suggest that guideline committees “should increasingly turn their efforts towards the production of tools that help clinicians to understand and share decisions on the basis of best evidence.” They acknowledge that shared decision making “does not guarantee lower resource use” and that reducing wasteful and harmful healthcare “will require commitment from both doctors and patients, in addition to objective evidence of effectiveness.” But they say it is time for action “to translate the evidence into clinical practice and truly wind back the harms of too much medicine.”

Professor Dame Sue Bailey, Chair of the Academy of Medical Royal Colleges said, “The whole point of Choosing Wisely is to encourage doctors to have conversations with their patients and explain honestly what the value of a treatment is. It’s not and will never be about refusing treatment or in any way jeopardising safety. It’s just about taking a grown-up approach to healthcare and being good stewards of the resources we have.”