Intended for healthcare professionals


Helping patients choose wisely

BMJ 2018; 361 doi: (Published 15 June 2018) Cite this as: BMJ 2018;361:k2585
  1. Jack Ross, clinical fellow, Choosing Wisely UK1,
  2. Ramai Santhirapala, clinical lead, Choosing Wisely UK1,
  3. Carrie MacEwen, chair1,
  4. Angela Coulter, health policy analyst and researcher2
  1. 1Academy of Medical Royal Colleges, London, UK
  2. 2Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to: J Ross jack.ross{at}

New UK recommendations emphasise shared decision making

Overdiagnosis and overtreatment are common, harmful to patients, and expensive.12 Doctors and patients tend to overestimate the benefit and underestimate harm of interventions.34 Choosing Wisely is a medically led campaign focusing on engaging doctors and patients in decisions about potentially unnecessary medical tests, treatments, and procedures. It started in the US in 2012 and has now been taken up in 22 countries worldwide, including the UK.5

The funding system in the UK means that NHS doctors have fewer financial incentives to overuse medical care than those working in fee-for-service systems, and the National Institute for Health and Care Excellence (NICE) has identified clinical interventions deemed to be of low value since 1999.6 Yet there is still evidence of wide clinical variation—for example, the first NHS Atlas of Variation showed a 27-fold difference in the rate of diagnostic knee arthroscopy procedures across the country.7 This variation is not usually because any specific investigation or treatment is redundant but because different clinical thresholds are used and they are not sufficiently tailored for individual patients’ needs. A new strategy involving patients …

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