Bioethics Blogs

Two Cheers for Choosing Wisely

The Choosing Wisely campaign is one of the most exciting experiments in health care in quite a while. If it lives up to its potential, Choosing Wisely could prevent some of the harm caused by unnecessary tests and treatments, while helping to bring down medical costs. But the real challenge to the campaign is whether it actually “empowers” consumers to do anything other than hurl themselves at a brick wall.

Choosing Wisely, begun in 2012, challenges medical specialties to create lists of the five most commonly misused and overprescribed interventions. Today there are more than 50 lists. Consumers Union is helping the campaign to bring its message to consumers in user-friendly form. And, indeed, the campaign is doing a wonderful job. The website (choosingwisely.org) has not only the lists, but terrific back-up resources to help laypeople understand the reasoning behind the lists. There are explanations about everything from why to avoid feeding tubes for Alzheimer’s patients, to how often one needs a colonoscopy.

True, Choosing Wisely is a work in progress. I wish dentists and orthodontists would sign on. And the current lists have been criticized for focusing on low-ticket items or on interventions performed by other specialties. Number one on the list from the American Academy of Ophthalmology, for example, is routine electrocardiograms (EKGs) before cataract surgery, a relatively low cost intervention provided commonly by primary care physicians.

The rationale for the campaign is to “educate and empower” consumers (whom they insist on calling “patients”) and to “promote conversations between providers and patients.” The goal is to help consumers choose care that is evidence-based and not harmful.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.