There are two parts to Choosing Wisely – the “Five Things” and then the bit where “Physicians and Patients Should Question” them. Most specialities – for better or worse – have generated lists of five things. Some go beautifully against the grain, like Pediatric Hospital Medicine. Others are criticized for mostly what is lacking.
Regardless, these suggestions work only when physicians are aware of them, and their suggestions are practical. This survey of outpatient physicians in a group in the state of Massachusetts, unfortunately, is rather bleak. At best, 47.2% of primary care physicians were aware of Choosing Wisely, compared with a mere 27% of surgical specialists. In a similar pattern, less than half and then less than a quarter of PCPs and surgeons felt Choosing Wisely was “Yes, absolutely” a legitimate source of guidance. Finally, just over half of all physicians surveyed felt the Choosing Wisely campaign had empowered them to reduce testing and procedures.
This is, of course, better than zero – which was effectively the base case. That said, these authors identified many barriers to their use. Physicians preferred to serve their patients desires and interests over the guidelines and recommendations made based on medical evidence. Further, most all physicians expressed a fear of malpractice and legal difficulties.
Awareness, certainly, would be a start. Then, making these recommendations usable in practice – moreso than then currently are – might be the next step in helping physicians bring them into the conversation.
“Physician Perceptions of Choosing Wisely and Drivers of Overuse”