April 4 marked the fifth anniversary of the launch of the Choosing Wisely campaign. While we at the Foundation have much to celebrate as we look back at our accomplishments over the past five years, I wonder what this anniversary means to you, your family, your patients, and to society as a whole. This moment is an opportunity for us here to reset our goals for the campaign and dig in a little deeper to achieve them.
In my head I’ve been hearing the refrain from Miles Davis’s song “So What” off his Kind of Blue album. Asking “so what” as we look at the laundry list of what we have achieved with Choosing Wisely reminds us that we cannot afford to rest on our laurels; this fifth anniversary is merely a start to the work left to be done.
True, the campaign has grown to 75 specialty society partners who have developed over 490 recommendations of tests and treatments they say are overused and clinicians and patients should discuss. But so what? We need to continue to grow these numbers.
Clinicians and patients are becoming more aware of the issue of unnecessary care. We are seeing a dramatic increase in journal articles discussing the science and evidence behind the recommendations, and studies on how to decrease their use. Physicians are also feeling more empowered to do something about the problem and more comfortable discussing low-value care with their patients.
This growing awareness has also led other groups to take up the cause of overuse. Medical students and trainees are becoming engaged in a number of educational initiatives, and health services researchers are beginning to learn and collaborate with one another about ways to address low-value care. But so what? We need to have awareness and engagement “built in” to the system and behavioral change among both clinicians and patients.
We have seen the campaign spread to hundreds of delivery systems and the development of statewide efforts (Connecticut, Washington, Rhode Island and soon Delaware). And while the ABIM Foundation is focused on addressing overuse domestically, it’s wonderful to see Choosing Wisely inspire similar campaigns in 18 other countries across the world. But so what? We need to prove that change can be replicated in diverse settings in communities across the country and demonstrate how the movement can be adapted and spread.
The problems facing us are complex—there are lots of forces driving overuse, including a fee-for-service system that has perverse incentives. Old habits and established protocols are not changed quickly. Education is important, but education alone is not sufficient to overcome inertia. Larger system-level changes, such as order entry, electronic medical record alerts and data feedback to physicians, have proven more effective at fostering behavior change.
We are still Choosing Wisely five years later, still as committed as we were in 2012 to the ideals that first brought about this campaign. So what? So… we are improving safety and quality and affordability in healthcare and will continue the charge for the next five years to come.
Daniel B. Wolfson
EVP & COO, ABIM Foundation