Can doctors reduce harmful medical overuse worldwide?

The Choosing Wisely campaign began in the United States in 2012, founded by the American Board of Internal Medicine (ABIM) Foundation. It helps specialists to agree lists of interventions that should be used with more caution because they are often unnecessary and therefore wasteful and potentially harmful (see box 1 for examples). More than 60 US specialist societies will have created lists by the end of 2014. One of many interventions flagged as a source of potentially harmful overdiagnosis and overtreatment is medical imaging soon after the onset of low back pain in the absence of other red flag signs or symptoms. Doctors reached this conclusion because evidence shows that most people get better within about amonth. Patients who have radiography, computed tomography, or magnetic resonance imaging are likely, however, to end up having more surgery at more cost while recovering in about the same time on average as patients who have no imaging. Hence the first statement on the American Academy of Family Physicians’ ChoosingWisely list is, “Don’t do imaging for low back pain within the first six weeks, unless red flags are present.” Others cautions on the academy’s list include, “Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement”; “Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age”; and “Don’t screen adolescents for scoliosis.” As well as engaging doctors, Choosing Wisely runs public relations campaigns to communicate to patients that more and costlier medicine is not always better. In the US the campaign partners with the consumer advocate organisation Consumer Reports (http://consumerhealthchoices.org). This two pronged approach aims to promote a culture change by facilitating “dialogue between specialists, GPs, and the public about tests, drugs, and procedures,” according to Wendy Levinson, professor at the University of Toronto’s school of medicine and the chair of newly launched Choosing Wisely Canada. Levinson was speaking at a Choosing Wisely meeting in Amsterdam this month that sought to capitalise on the international interest in the campaign. Twelve countries were represented, including Australia, the Netherlands, Japan, Germany, Italy, and the UK, each developing, or contemplating developing, campaigns of their own. A key message was that new campaigns should focus on encouraging better care rather than cutting costs, even though savings may also result. “Quality, safety, waste, harm” was the mantra—and avoid mentioning cost. Winning over doctors