Choosing Wisely

Choosing Wisely is a United States–based health educational campaign, led by the ABIM Foundation (American Board of Internal Medicine), about unnecessary health care.

The campaign identifies over 500 tests and procedures and encourages doctors and patients to discuss, research, and possibly get second opinions, before proceeding with them. To conduct the campaign, the ABIM Foundation asks medical specialty societies to make five to ten recommendations for preventing overuse of a treatment in their field. The foundation then publicizes this information, and the medical specialty societies disseminate it to their members.

The campaign has garnered both praise and criticism, and some of its ideas have spread to other countries. It does not include evaluation of its effects on costs, on discussions or on medical outcomes. Some doctors have said they lack time for the recommended discussions.

In 2002 the ABIM Foundation published Medical professionalism in the new millennium: a Physician Charter. The charter states that physicians have a responsibility to promote health equity when some health resources are scarce. As a practical way of achieving distributive justice, in 2010 physician Howard Brody recommended that medical specialty societies, being stewards of a field, ought to publish a list of five things which they would like changed in their field and publicize it to their members. In 2011, the National Physicians Alliance tested a project in which it organized the creation of some "top 5 lists". Analysis of the National Physician's Alliance project predicted that the health field could have saved US$6.8 billion in 2009 by cutting spending on the 15 services in the lists from three societies, out of total US health spending that year of US$2.5 trillion. US$5.8 billion of the savings were from one recommendation: using generic rather than brand name statin.

Continuing this project, Choosing Wisely was created to organise the creation of more "lists of five," later ten, and their distribution to more physicians and patients. Executive boards of societies, with or without participation by members, identify practices which their field may overuse. Each recommendation in the program must have the support of clinical guidelines, evidence, or expert opinion.

To participate in Choosing Wisely, each society developed list of tests, treatments, or services which that specialty commonly overuses. The society shares this information with their members, as well as organizations who can publicize to local community groups, and in each community patients and doctors can consider the information as they like. The ABIM Foundation gave grants to help societies participate.

As of April 2018, there were 552 recommendations targeting a range of procedures to either question or avoid without special consideration. They can be searched online by key words, such as "back pain" but the numerous supporting footnotes on each recommendation are only in a pdf on the clinician page, without links to the papers.

Between 2012 and 2023, more than 80 specialty societies highlighted examples. While these examples are no longer maintained and available on the website (www.choosingwisely.org), specialty societies are encouraged to publish individual lists. Many of these lists are accessible through https://www.aafp.org/pubs/afp/collections/choosing-wisely.html.