Reducing overuse in healthcare: advancing Choosing Wisely

The threats of overuse in healthcare are increasingly well characterised, affecting patients, providers, and health systems.1 Estimates from Canada and the United States show that up to 30% of all medical care adds no value and might cause harm.2 From the global threat of antimicrobial resistance to side effects from unnecessary tests or treatments, harms associated with overuse take many forms. The complexity of the problem, combined with heterogeneity and fragmentation in the body of research underpinning our understanding, has meant that solutions to overuse in healthcare have so far been elusive.3

Launched in 2012 in the US, Choosing Wisely was intended to galvanise doctors to lead on this issue by establishing specialty specific recommendations on overused tests, treatments, and procedures. In the seven years since, the movement has expanded to more than 20 countries. As the campaign matures, questions are beginning to arise about the value of developing and disseminating such lists, whether these efforts are sufficient to make progress in tackling overuse, and what else can be done.

In many countries the initial goal of Choosing Wisely was to raise awareness about overuse and to draw attention to the rationale for tackling it. Awareness is the first step, but influencing the established practice of doctors requires much more than a voluntary effort of specialty societies. Overuse is a multifactorial problem situated at the intersection of doctor habits, behaviours, and training, compounded by public and patient expectations and demands. A considered and evidence based approach is needed.4