Intended for healthcare professionals

Feature Shared Decision Making

Can doctors reduce harmful medical overuse worldwide?

BMJ 2014; 349 doi: (Published 03 July 2014) Cite this as: BMJ 2014;349:g4289
  1. Richard Hurley, deputy magazine editor
  1. 1The BMJ, London, UK
  1. rhurley{at}

A US campaign to help doctors decide which interventions are often unnecessary and wasteful is catching on worldwide, reports Richard Hurley

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.

Box 1: Examples of commonly overused interventions discussed at the meeting

  • Imaging for low back pain

  • Imaging for headaches

  • Antibiotics for upper respiratory tract infections

  • Dual energy x ray absorptiometry

  • Preoperative testing in low risk patients (electrocardiography, stress electrocardiography, chest radiography)

  • Antipsychotics in older patients

  • Artificial nutrition in patients with advanced dementia or advanced cancer

  • Proton pump inhibitors in gastro-oesophageal reflux disease

  • Urinary catheter placement

  • Cardiac imaging in low risk patients

  • Induction of labour

  • Cancer screening (cervical smear test, CA-125 antigen for ovarian cancer, prostate specific antigen screening)

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.1 Doctors reached this conclusion because evidence shows that most people get better within about a month.2 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’ Choosing Wisely list is, “Don’t do imaging for low back pain within the first six weeks, unless red flags are present.”3

Others cautions on the academy’s list include, “Don’t routinely prescribe antibiotics for …

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