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Best Choose Wisely

Over diagnosis and overtreatment are the products of a broken system,” – strong words by Aseem Malhotra in an interview with the BBC (1).

Malhotra is lead author of a recent report by the Academy of Medical Colleges (AoMRC) (2), and it seems as though the UK-based group is on a mission: to “reduce the harms of too much medicine”. They argue that doctors have an ethical responsibility to cut down on “wasted use of clinical resource because, in a healthcare system with finite resources, one doctor’s waste is another patient’s delay.” And it’s looking to its American colleagues for inspiration.

The Choosing Wisely initiative in the US and Canada was set up to stop doctors using interventions that are not supported by evidence, are unnecessary or are duplicated. With the help of medical organizations, the campaign has compiled top five lists of interventions for each specialty that should not be used routinely, if at all. So far, 60 specialist societies in the US have joined Choosing Wisely since its introduction in 2012. Has it been effective? The jury’s still out; a recent telephone survey of 600 US doctors found that only 21 percent had heard of Choosing Wisely, despite the publicity around the campaign (3). It has gained international following though; to date it’s been adopted in Australia, Germany, Italy, Japan, the Netherlands, and Switzerland.

Now the UK wants a bit of the action. AoMRC is spearheading its own Choosing Wisely campaign and hopes to have its top five specialty lists later this year. It acknowledges that it will likely not be successful unless it has the backing of patients, but with some patient groups and charities fearing that people could miss out on a crucial, early diagnosis, how realistic is this? And how confident are doctors in their own knowledge of benefits versus risks?

With doctors being caught between the demanding patient, pricing and workload pressures, and a plethora of often confusing statistics, it’s no wonder that cynicism of change remains. Tim Allen (@TimAllenMDJD) recently highlighted the closing sentence of the recent BBC news report on the initiative via Twitter: “there is no guarantee that this approach will necessarily reduce the use of unwarranted and sometimes harmful tests.” One thing that is guaranteed though, is pathologists’ vital role in supporting improved test utilization and in securing the best overall outcome for the patient. How? Take a look at Mike Hallworth’s poster below, where he clearly highlights all of the ways that laboratories can deliver exceptional patient care.

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  1. S Mundasad, “Doctors urged to stop ‘over-treating’ ”, BBC News, May 13, 2015. bbc.in/1Hd1L1E. Accessed May 15, 2015.
  2. A Malhotra, et al., “Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine”, BMJ, 350, h2308 (2015).
  3. PerryUndem Research/Communication, “Unnecessary tests and procedures in the health care system: what physicians say about the problem, the causes, and the solutions: results from a national survey of physicians” (2014). bit.ly/1HhItbt.
About the Author
Fedra Pavlou

After graduating with a pharmacology degree, I began my career in scientific publishing and communications. Now with more than 16 years of experience in this field, my career has seen me heading up editorial and writing teams at Datamonitor, Advanstar and KnowledgePoint360 group. My past experiences have taught me something very important – that you have to enjoy working with, and have respect for your colleagues. It’s this that drew me to Texere where I now work with old colleagues and new. Though we are a hugely diverse team, we share several things in common – a real desire to work hard to succeed, to be the best at what we do, never to settle for second best, and to have fun while we do it. I am now honored to serve as Editor of The Pathologist and Editorial Director of Texere Publishing.

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