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Choosing wisely: the message, messenger and method

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Insights to guide Choosing Wisely activities in Australia, based on a South Australian Clinical Senate exercise

International movements are seeking to identify and reduce the use of health care services that provide little or no benefit, whether through overuse or misuse. England’s National Institute for Health and Clinical Excellence commenced a formal policy agenda in this area in 2005;1 however, the first truly physician-driven exercise commenced in 2009 in the United States.

The American Board of Internal Medicine Foundation invited professional societies to step forward as “stewards of finite health care resources”.2 Initially, groups of volunteers from three primary care specialties developed top-five lists. These lists described specialty-specific practice changes that would improve patient outcomes through better treatment choices, reduce risks and, where possible, reduce costs.

In 2012, the program was formally launched as the Choosing Wisely campaign, involving lists from nine specialty societies and including a patient-education component. In 2014, about 50 additional specialty societies joined, and clinicians put forward hundreds of health care practices as being interventions of limited value.2

The US Choosing Wisely campaign is unique in how it has framed its message, who…