News CMAJ Choosing Wisely concept has universal appeal t began in the United States in 2012. Canada joined in 2014. It has since I spread to Japan, Brazil, France, Germany, Israel, Australia and many other countries. The concept behind the Choosing Wisely campaign — that more health care isn’t always better health care — appears to have universal appeal. And that’s a rare thing on the international health care scene. “It transcends all these different health care systems and different pay- ment schemes because it resonates with doctors about the core essence of what it is to work with patients, and that is the same in every country,” says Dr. Wendy Levinson, chair of Choosing Wisely Canada and a pro- fessor of medicine at the University of Toronto. “That is the amazing part of skynesher/iStock this story. Give me another example Physicians in many countries agree that reducing the use of some medical tests, such as where there has been so much interest MRI scans, is a good idea. across countries in anything about changing health care systems.” The success across borders of tiums held over the past three years in If there were international discus- Choosing Wisely is even more amaz- Amsterdam, London and Rome. It is sions about how best to fund health ing, says Levinson, when you consider the Canadian team that pushed for the care, for example, there would likely the financial incentives for physicians Commonwealth Fund to include ques- be many different opinions. Talks — there are none. No one is getting tions on overuse in its surveys. Choos- between countries on how best to pay paid to choose wisely, she says. Sure, ing Wisely Canada is also responsible doctors would be a “dog’s breakfast,” health systems that reduce overuse may for overuse indicators appearing in says Levinson. The Choosing Wisely save some money, but the campaign is Health at a Glance 2015 by the Organ- concept, on the other hand, has seen really about quality improvement and isation for Economic Co-operation few detractors. harm prevention, about delivering high- and Development (OECD). “If we hadn’t articulated the impor- “It’s about the day-to-day practice tance of it to the OECD, they wouldn’t have done it,” says Levinson. of medicine.... It’s about helping more Canada is not only leading, but also learning from Choosing Wisely suc- and harming less.” cesses in other countries. Israel and Australia, for example, have shown That’s because it is at the core of quality, appropriate care for patients tremendous capacity to measure the physician professionalism, says Levin- based on the best available evidence. effects of Choosing Wisely initiatives, son. It’s about the day-to-day practice But even such an appealing concept thanks to their excellent systems of of medicine — working with patients — providing value in health care — electronic health records. to decide which tests are really neces- can only spread across the world if “We want to keep learning from sary, which drugs they really need, someone takes leadership of the initia- each other, growing measurement and how much care is enough and how tive. In this case, that leader is Canada. teaching the public that more is not much is too much. It’s about helping “We are kind of the consultants to always better,” says Levinson. — more and harming less. the other countries,” says Levinson. Roger Collier, CMAJ “The work of doctoring is the same It is the Canadian team that orga- in every country,” says Levinson. nized and ran the international consor- CMAJ 2016. DOI:10.1503/cmaj.109-5291 E276 CMAJ, September 6, 2016, 188(12) © 2016 Joule Inc. or its licensors.