The challenge of doing less

“It is difficult to get a man to understand something, when his salary depends upon his not understanding it,” said the US social reformer Upton Sinclair. But that is the challenge taken on by the Choosing Wisely campaign.

The idea of asking specialty societies to produce lists of five overused procedures was first suggested in 2010 by Howard Brody, professor of family medicine and director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston. Writing in the New England Journal of Medicine, he argued that physicians’ professional organizations were not doing their part to control rising costs, and in some cases had even made their support for reform contingent on promises that physicians’ income would not be negatively affected.1

“The myth that physicians are innocent bystanders merely watching healthcare costs zoom out of control cannot be sustained,” he wrote. “If physicians seized the moral high ground, we just might astonish enough other people to change the entire reform debate for the better.”

Brody’s challenge was taken up by the ABIM Foundation, a not-for-profit group that was established in 1999 by the American Board of Internal Medicine with a mandate to advance medical professionalism and physician leadership in improving the health system. The result was the Choosing Wisely campaign, which has recruited more than 50 specialty societies to each produce a list of five procedures that are overused in their field. The third, biggest, and final planned wave of Choosing Wisely lists is currently being released, and when it concludes early next year it will comprise more than 300 recommendations, all of them beginning with …