Choosing Wisely Canada

623:, since majority of patients with hypothyroidism will present with abnormal TSH levels. A baseline audit at Women's College Hospital revealed that 60% of all free thyroid hormones tests were performed in patients who had normal TSH levels, amounting to approximately $ 50,000 annually in additional laboratory testing expenditure. A "Reflex T4" approach was implemented at WCH, wherein free T4 tests would not be conducted unless TSH levels are abnormal, or if there are clinical indications of situations when measurement of free thyroid hormones would be necessary. When it is found that TSH levels are abnormal, free T4 levels would then be automatically measured. In addition to reducing inappropriate thyroid function testing, the impact of Choosing Wisely Canada is felt through numerous physician and patient awareness campaigns conducted at the hospital. 548:"quasi-systematic methods that focus on physician participation to increase support". The critique additionally called for increased evidence of the efficacy of the "Top Five" lists in terms of reduction in wasteful practices. Clement and Charlton furthermore warn of "Top Five List Burnout", noting that when faced with multiple guidelines on a single topic, physicians become confused regarding which protocol to follow. In spite of these criticisms, Clement and Charlton "strongly believe in the global spirit behind the Choosing Wisely campaigns and movement" and "advocate that the priority in 2015 should be thoughtful implementation and rigorous evaluation of existing top five lists". 434:

curricula, and demonstrated reduction in unnecessary testing following campaign efforts. Measuring progress of reduction in inappropriate care is particularly complex, since "the definition of appropriateness often includes knowing about symptoms and physical exam findings often not included in electronic health records and administrative databases". Recognizing the complexity of evaluation efforts, Choosing Wisely Canada along with other international Choosing Wisely movements is working with the Organization for Economic Co-operation and Development to develop metrics that might be used to compare countries on specific measures of overuse, as well to develop cross-country metrics.

581:. The trial recruited more than 300 patients aged 65–95 years in the greater Montréal area who were long term users of benzodiazepines. Approximately half the patients were exposed to educational intervention, which included Choosing Wisely recommendations around excessive benzodiazepine therapy. The patients were then followed for 6 months. The study found that 62% of patients who received the intervention initiated conversation regarding benzodiazepine therapy discontinuation with physicians and/or pharmacists. After six months, 27% of the intervention group had stopped taking benzodiazepines, compared with 5% of the patients who did not receive the educational intervention. 280:

promote conversation about inappropriate care. The underlying premise is that clinicians must lead such conversations, since they determine the appropriate or inappropriate use of resources. CWC has also developed complementary patient-friendly education materials, and has begun to embed lessons focusing on resource stewardship in undergraduate and postgraduate medical curricula. In order to unify grassroots projects occurring across Canada to implement clinician recommendations, CWC additionally developed the Early Adopters Collaborative, which serves as a "learning platform for sharing knowledge, tools and experiences among participating organizations".

592:, one of the early adopters of the campaign. A multi-faceted campaign was implemented particularly in the hospital Emergency Department in June, 2014. Test utilization in the Emergency Department was analyzed between September 15 and November 21, 2014, and compared to the same 10-week period in 2013 to account for any seasonal variances. The study found a 41% decline in the number of laboratory tests ordered pre- and post- CWC program implementation, without any observable change in outcomes. A preliminary cost analysis revealed annual departmental savings of approximately $ 215,000 while maintaining the same quality of care. 225: 289: 451: 166: 438:

have questions. As such, a major portion of the campaign focuses on encouraging patients to initiate conversations about unnecessary care. Additionally, Choosing Wisely Canada has developed patient-friendly materials with straightforward, lay language to explain common tests, with a "When you need them and when you don't" approach. These materials complement the lists of "Five Things Physicians and Patients Should Question" developed by specialty societies.

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about the tests, treatments and procedures used within various medical specialties, when they may or may not be necessary, and what patients can do to improve their overall health. For example, one of the patient educational materials released on June 2, 2015, addressed concerns regarding the amount of bed rest required to treat lower back pain, advising that staying in bed longer than 48 hours will not help, and in fact, may actually delay recovery.

20: 496:, highlights two aspects of the campaign that he believes are unique and have great potential. "The first", he states, "is that it's targeted to the public, and the second is that it's driven not only by scientists and medical journals, but by the professional organizations themselves. For radiologists to come forward and say you shouldn't order radiology tests under these circumstances, this is unprecedented". 511:, saluted Choosing Wisely Canada "as an innovative physician-led and patient-centered approach that has the potential to shift healthcare away from a culture of consumption to a focus on appropriateness and quality of care". Furthermore, the panel urged "governments to support the implementation of in all jurisdictions and to carefully evaluate its impact". 482:, notes "Physicians are really embracing the principles behind Choosing Wisely. It's all about the right thing to do for patients and avoiding the harm that can come from unnecessary testing. Let's do more of what works and…and less of what is done 'just in case'. Society expects us to lead the way, and the physicians of Canada intend to do just that". 74:

to foster discussions between patients and clinicians about inappropriate care. The campaign also uses patient-friendly education materials to complement these lists, as well as teaches medical trainees about resource stewardship. As of June 2, 2021, 400 clinician recommendations and 39 lay language patient educational materials have been released.

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health care resources for optimal patient care" and "to apply evidence and management processes to achieve cost-appropriate care". In order to embody these ideals, CWC is working with Canadian medical schools to introduce new content focussing on resource stewardship into the undergraduate, postgraduate and continuing medical education curricula.

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initiative to find innovative ways to put the recommendations into practice. Such local implementation efforts are beginning to emerge across Canada, with activities ranging from clinician and patient education, to modifying clinical processes and information systems, to providing data back to providers about their practice patterns.

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for practicing conservative medicine. Such a system may create a pattern for physicians to recommend more treatment. This pattern may also contribute to unwilling of physicians to put recommendations on their lists pertaining specifically to their specialty, instead focusing their recommendations on overuse by other specialties.

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Some physicians report feeling pressure to engage in defensive medicine (e.g., ordering more tests than necessary) because they feel that it will help them avoid litigation. The Canadian healthcare system is also set up so that specialty physicians get paid for tests and procedures conducted, and not

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Choosing Wisely Canada recommendations are not intended to be used to establish payment and coverage decisions. Rather, the lists are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, Choosing Wisely Canada recommends that its materials

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and subsequently became a national movement. The second and third waves of physician recommendation lists and patient education materials were launched on October 29, 2014, and June 2, 2015, respectively. As of June 2, 2015, more than 80 Canadian medical specialty societies are engaged and at various

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have committed to initiating similar campaigns revolving around medical stewardship and low-value care in their respective countries. Italy has integrated the principles of Choosing Wisely in a campaign called "Doing more does not mean doing better", and the Netherlands has launched "Choosing Wisely

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Since patient education is a core facet of the campaign, communication with patients presents another challenge. Some campaign recommendations may require clinical education for complete comprehension. Furthermore, many patients tend to follow physician recommendations without question, even if they

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In order to encourage patients to initiate conversations about unnecessary care, Choosing Wisely Canada uses patient-friendly materials with lay language to complement the lists of "Five Things Clinicians and Patients Should Question". These patient educational materials are meant to inform patients

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Central to the campaign are lists of "Things Clinicians and Patients Should Question" developed by more than eighty Canadian specialty societies. These lists are intended to encourage clinicians to adopt a "think twice" attitude to avoid unnecessary and potentially harmful tests and procedures, and

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On the other hand, early criticism of Choosing Wisely in the United States highlighted that some specialty recommendations addressed overuse of resources by primary care specialties, instead of addressing unnecessary tests and procedures conducted by their own specialty colleagues. Choosing Wisely

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and poor clinical outcomes, including higher mortality. A systematic survey of patients in seven countries revealed that 10–20% of patients believed that their physicians had provided treatment of little or no value in the past two years. Further studies highlighted the financial strain of medical

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Another major aspect of the campaign is engaging medical trainees at all levels. The Draft 2015 CanMEDS Framework identifies leadership as one of seven essential physician competencies, urging medical professionals to "engage in the stewardship of health care resources", particularly to "allocate

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Choosing Wisely Canada stems from worldwide concern around providing unnecessary treatment when the risk of harm exceeds its potential benefit ("medical overuse"). A number of studies have highlighted the prevalence of medical overuse in Canada, which include findings that approximately 50% of

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Healthcare stakeholder groups have mobilized around the CWC campaign at provincial and local levels. Choosing Wisely Canada has regional campaigns in all provinces and territories. At the local level, hospitals, health regions and clinician groups across the country are working under their own

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has adopted a multi-faceted campaign approach, engaging clinicians, patients, and medical trainees at all levels. The campaign has partnered with more than 80 Canadian medical specialty societies to develop evidence-supported lists of "Things Clinicians and Patients Should Question", hoping to

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Many physician bloggers assert that most medical overuse is a result of practicing defensive medicine in an effort to avoid lawsuits. Others recognize the noble goal of reducing overuse and harm, but lament that the lists are too simplistic and do not necessarily advance the identification of

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Evaluation of the campaign has also been identified as a major challenge. Campaign leaders concede that measuring the impact of Choosing Wisely is complex and may require multiple approaches, including physician and patient awareness of the campaign, documented curriculum inclusion in medical

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At the core of the campaign are lists of "Things Clinicians and Patients Should Question" developed by national specialty societies representing a broad spectrum of clinicians. These lists contain tests, treatments or procedures commonly used in their specialty, but which are not supported by

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aims to encourage and empower physicians to assimilate, evaluate, and implement the ever-increasing amount of evidence on current best practice. The campaign also supports the equally important role of patient education and the need to dispel the false notion that "more care is better care".

470:, lists Choosing Wisely Canada as one of three major ideas to improve Canadian healthcare, highlighting that "Choosing Wisely Canada is not a rationing or cost-cutting exercising. It is about reorganizing healthcare services so we only do things for people that truly benefit their health." 547:

by Clement and Charlton highlights a number of shortcomings in the overall movement. While the critique commends the campaign for succeeding in its goal of promoting conversations about low-value care, the authors of the critique believed that the process of list development were based on

426:, which could in turn "undermine both physician engagement and patient trust." Consequently, the campaign is centered around patient safety with particular emphasis on quality of care. Furthermore, Choosing Wisely Canada recommendations do not determine payment for individual services. 215:

found up to 30% of tests and treatments were unnecessary based on eight campaign recommendations. In light of these concerns, Choosing Wisely Canada hopes to optimize value, reduce waste and improve patient outcomes by promoting patient-physician conversations about low-value care.

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Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, E. L. (2003). The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Annals of Internal Medicine, 138(4),

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Choosing Wisely Canada recommendations range from avoiding overuse of broad practices such as unnecessary and potentially harmful screening, diagnostic and radiographic services, to specific tests which are not supported by evidence to improve patient outcomes.

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Mitera, G., Earle, C., Latosinsky, S., Booth, C., Bezjak, A., Desbiens, C., ... & Porter, G. (2015). Choosing Wisely Canada Cancer List: Ten Low-Value or Harmful Practices That Should Be Avoided In Cancer Care. Journal of Oncology Practice, 11(3),

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Campaign leaders have identified a number of challenges which could potentially undermine the efforts of Choosing Wisely Canada. Since reducing unnecessary tests and procedures may result in lowering healthcare costs, the campaign may be viewed as a

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On the media front, the campaign includes partnerships with patient organizations and media outlets to develop and disseminate complementary content to increase patient awareness, and to support them in conversations surrounding inappropriate care.

248:, a Canadian physician and previous chair of the ABIM Board of Directors, was involved in launching the Choosing Wisely campaign in the United States. After its successful launch, she decided to bring the movement to Canada and partnered with the 1255:

Gilmour, J., Weisman, A., Vecchiarelli, J., Orlov, S., Goldberg, R. J., & Goldberg, A. (2015). THR-191: Reducing Inappropriate Thyroid Function Tests at an Academic Ambulatory Hospital: Baseline Assessment for a Quality Improvement

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Wang, E. E., Einarson, T. R., Kellner, J. D., & Conly, J. M. (1999). Antibiotic prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections. Clinical infectious diseases, 29(1),

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Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014

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Natarajan MK, Paul N, Mercuri M, Waller EJ, Leipsic J, Traboulsi M, et al. Canadian Cardiovascular Society position statement on radiation exposure from cardiac imaging and interventional procedures. Can J Cardiol. 2013

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Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ. 2010 Nov 23;182(17):1864-73.

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Canada responded to such criticisms by setting guidelines for its list development, which required recommendations put forward by specialty societies to pertain specifically to the specialty's scope of practice.

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scans are inappropriate. These unnecessary invasive procedures and low-value care are major causes of preventable harm and increased waste of medical resources. Medical overuse has been associated with decreased

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Schoen, C., Osborn, R., Doty, M. M., Bishop, M., Peugh, J., & Murukutla, N. (2007). Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Affairs, 26(6),

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as a part of the weekly feature titled "Doctor's Notes". The article highlighted the Choosing Wisely campaign and encouraged patients to engage in conversations with their physicians about unnecessary care.

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Hicks, L. K., Bering, H., Carson, K. R., Haynes, A. E., Kleinerman, J., Kukreti, V., ... & Wood, W. A. (2014). Five hematologic tests and treatments to question. ASH Education Program Book, 2014(1),

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Fenton JJ, Franks P, Feldman MD, Jerant A, Henry SG, Paterniti DA, Kravitz RL. Impact of patient requests on provider-perceived visit difficulty in primary care. J Gen Intern Med. 2015 Feb;30(2):214-20.

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Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA; Choosing Wisely International Working Group. 'Choosing Wisely': a growing international campaign. BMJ Qual Saf. 2015 Feb;24(2):167-74.

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Morden, N. E., Colla, C. H., Sequist, T. D., & Rosenthal, M. B. (2014). Choosing wisely—the politics and economics of labeling low-value services.New England Journal of Medicine, 370(7), 589-592

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Wolfson D, Santa J, Slass L. Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the choosing wisely campaign. Acad Med. 2014 Jul;89(7):990-5.

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Wolfson D, Santa J, Slass L. Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the choosing wisely campaign. Acad Med. 2014 Jul;89(7):990-5.

722:. It receives funding from the Canadian Medical Association, along with grants from federal, provincial and territorial ministries of health, and other partner organizations and agencies. 1440: 462:

The response to Choosing Wisely Canada has been positive, with clinicians across the country expressing support for the campaign and highlighting the need for more resource stewardship.

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List items recommend practices to be avoided and typically begin with the word "Don't" or "Avoid"; for example, one of the recommendations released in the first wave of the campaign was

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entitled EMPOWER (Eliminating Medications Through Patient Ownership of End Results), led by Cara Tannenbaum, geriatrician and professor in the Faculties of Medicine and Pharmacy at the

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In addition to endorsements from eminent physician leaders and professional organizations, Choosing Wisely Canada received positive media coverage in national media sources, including

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stages of recommendations development. In total, 400 clinician recommendations and 39 lay language patient educational materials have been released in the three waves from 2014–2015.

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The campaign is based on the notion that unnecessary tests, treatments, and procedures often do more harm than good, resulting in poor clinical outcomes and significant waste in the

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leads an international community, made up of nations who are implementing similar programs in their respective countries. At present, this community includes representation from

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The Endocrine Society. Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrinology Society Clinical Practice Guideline . 2010 . Available from:

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Emery, D. J., Shojania, K. G., Forster, A. J., Mojaverian, N., & Feasby, T. E. (2013). Overuse of magnetic resonance imaging. JAMA Internal Medicine,173(9), 823-825.

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Smith, C. D., & Levinson, W. S. (2015). A Commitment to High-Value Care Education From the Internal Medicine Community. Annals of Internal Medicine,162(9), 639-640

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Levinson W, Huynh T. Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada. CMAJ. 2014 Mar 18;186(5):325-6.

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Frank, J. R., Snell, L., & Sherbino, J. (2014). The Draft CanMEDS 2015: Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada

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Levinson W, Huynh T. Engaging clinicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada. CMAJ. 2014 Mar 18;186(5):325-6.

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Shah N, Levy AE, Moriates C, Arora VM. Wisdom of the Crowd: Bright Ideas and Innovations From the Teaching Value and Choosing Wisely Challenge. Acad Med. 2015 Jan 6.

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Canadian Medical Association . Choosing Wisely Canada.Ottawa, ON: Canadian Medical Association; 2014. Available from:www.cma.ca/En/Pages/choosing-wisely-canada.aspx.

471: 211:, which found that up to 30% of American health care spending is on unnecessary tests and procedures. In 2017, a joint report between Choosing Wisely Canada and the 1530:

Clement, F., & Charlton, B. (2015). Challenges in Choosing Wisely's international future: support, evidence, and burnout. JAMA Internal Medicine,175(4), 644-645

304:. National specialty societies are free to determine the process for generating their lists, as long as they are done in accordance with the following principles: 1640:

Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely—the politics and economics of labeling low-value services. N Engl J Med. 2014 Feb 13;370(7):589-92.

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Leon-Carlyle, M., & Srivastava, R. (2014). Medicine's Push for Resource Stewardship in Education and Practice. University of Toronto Medical Journal,92(2).

1394: 1474: 1335:, Loewenstein, G., & Asch, D. A. (2012). Choosing wisely: low-value services, utilization, and patient cost sharing. Jama, 308(16), 1635-1636. 1090:

Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring Low-Value Care in Medicare. JAMA Intern Med. 2014. Epub ahead of print.

61:. These unnecessary tests and procedures take away from care by potentially exposing patients to harm, leading to more testing to investigate 1128:

Gupta S, Detsky AS. Development of Choosing Wisely Recommendations for an Inpatient Internal Medicine Service. JAMA Intern Med. 2015 Feb 23.

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Horwitz LI, Masica AL, Auerbach AD. Introducing Choosing Wisely®: Next steps in improving healthcare value. J Hosp Med. 2015 Mar;10(3):187-9

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Bhatia, R. S., Levinson, W., & Lee, D. S. (2014). Low value cardiac testing and Choosing Wisely. BMJ quality & safety, bmjqs-2014.

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to launch Choosing Wisely Canada on April 2, 2014. In the first wave of the campaign, nine national medical specialty societies released

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Grady D, Redberg RF. Advancing medical professionalism and the choosing wisely campaign-reply. JAMA Intern Med. 2015 Mar 1;175(3):465.

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http://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20Guidelines/FINAL-Androgens-in-Men-Standalone.pdf

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Baron RJ, Wolfson D. Advancing medical professionalism and the choosing wisely campaign. JAMA Intern Med. 2015 Mar 1;175(3):464-5.

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Each recommendation is within the specialty's scope of practice (and not pertaining to other specialties such as family medicine)

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Under the leadership of Wendy Levinson and the Canadian Medical Association, Choosing Wisely Canada initially gained momentum in

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Tests, treatments or procedures included are those that (a) are frequently used, and, (b) may expose patients to harm or stress.

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Allin, S., & Rudoler, D. (2015). The Canadian Health Care System, 2014.International Profiles of Health Care Systems, 21.

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O'Callaghan G, Meyer H, Elshaug AG. Choosing wisely: the message, messenger and method. Med J Aust. 2015 Mar 2;202(4):175-7.

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Recommendations target overuse of unnecessary medical procedures. BCMJ, Vol. 57, No. 6, July, August 2015, page(s) 237–238.

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Canadian Association of Radiologists. Medical imaging primer with a focus on x-ray usage and safety . . Available from:

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Holton, E. Choosing Wisely: Tackling Unnecessary X-rays in the ICUS. St. Michael's Hospital Newsroom. Available at:

630:, where Choosing Wisely principles are integrated into the undergraduate and postgraduate medical curricula through 1460: 1637:

Bhatia RS, Levinson W, Lee DS. Low value cardiac testing and Choosing Wisely. BMJ Qual Saf. 2015 Feb;24(2):89-91.

1423:"Report of the Advisory Panel on Healthcare Innovation: "Unleashing Innovation: Excellent Healthcare for Canada"" 556:

Choosing Wisely Canada has identified a multifaceted evaluation approach to measure its impact, which includes:

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Following the example of Choosing Wisely in the United States and Choosing Wisely Canada, health leaders from

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lists of 41 tests, treatments and procedures that provided no benefit or potentially caused harm to patients.

54:, and to assist physicians and patients in making informed and effective choices to ensure high quality care. 1061:

Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste in US health care. Jama, 307(14), 1513-1516.

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Siemens DR, Finelli A. Choosing Wisely Canada: It's our turn. Can Urol Assoc J. 2014 Jul;8(7-8):E580-1.

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Choosing Wisely Canada has also partnered with a number of patient and community groups which include:

474:, past president of the Canadian Medical Association, Professor of Medicine and Chief of Cardiology at 322:

be used as guidelines for clinicians and patients to determine an appropriate treatment plan together.

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The campaign is also endorsed by all the Canadian provincial and territorial medical associations:

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Morgan DJ, Wright SM, Dhruva S. Update on medical overuse. JAMA Intern Med. 2015 Jan;175(1):120-4.

34:) is a Canadian-based health education campaign launched on April 2, 2014 under the leadership of 1024:

Morgan DJ, Wright SM, Dhruva S. Update on medical overuse. JAMA Intern Med. 2015 Jan;175(1):120-4

51: 631: 398: 1671: 711: 627: 423: 253: 208: 47: 1372:

Brody H. Talking with patients about cost containment. J Gen Intern Med. 2014 Jan;29(1):5-6.

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Hurley, R. (2014). Can doctors reduce harmful medical overuse worldwide?. BMJ, 349, g4289.

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The impact of Choosing Wisely Canada on test ordering and utilization was studied at the

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http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2015/20150624_hn

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http://www.car.ca/uploads/standards%20guidelines/20130128_en_guide_radiation_primer.pdf

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Harvey EJ. Choosing wisely (and carefully) Canada. Can J Surg. 2014 Jun;57(3):149, 151.

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or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.

379: 466:, family physician and Vice-President Medical Affairs and Health Systems Solutions at 479: 370:

Examples of recommendations which advise against overuse of broad practices include:

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Glauser W. Choosing Wisely campaign well received. CMAJ. 2014 May 13;186(8):E239-40.

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Netherlands", both contributing to a growing international Choosing Wisely movement

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Don't order screening chest X-rays and ECGs for asymptomatic or low risk outpatients

616: 375: 336: 50:. The campaign aims to help clinicians and patients engage in conversations about 1189: 600: 540:

low-value care, but merely synthesize "agreed-upon, well-established practices".

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Evaluation of campaign impact on patient education and receptiveness included a

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Examples of specific low-value tests to avoid in certain circumstances include:

620: 288: 257: 245: 35: 454: 224: 169: 1685: 1596: 1503: 409: 378:, or surveillance for a new primary cancer, in the majority of patients with 141: 560:

Physician attitudes and self-reported experience (through physician surveys)

65:, and contributing to unnecessary anxiety and avoidable costs for patients. 1479: 1234: 525: 504: 485: 402: 183: 179: 1441:"Medical Associations to Urge Canada's Doctors to Limit Unnecessary Tests" 1332: 694: 690: 686: 682: 599:

initiative based on CWC principles was launched under the supervision of

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Canadian Medical Association Forum on General and Family Practice Issues

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seminars, lectures, resident research projects and academic half days.

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The development process is thoroughly documented and publicly available

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Vogel, L. More Hospitals Choose Wisely.CMAJ June 8, 2015 cmaj.109-5078

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Association of Medical Microbiology and Infectious Disease Canada

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Dr. Danielle Martin's Three Ideas To Improve Canadian Healthcare

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The specialty societies participating in the campaign include:

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Medical education efforts of CWC are currently centered at the

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A critique of the Choosing Wisely campaign published in the

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evidence, and/or could expose patients to unnecessary harm.

1475:"Doctors Weigh in on 2013's Biggest Medical Breakthroughs" 914:

The national medical organizations endorsing CWC include:

1395:"Danielle Martin's Three Big Ideas to Improve Healthcare" 1230:"Why that medical test might not be necessary | The Star" 1006:"ANDRÉ PICARD: When health care becomes unnecessary care" 186: 566:

Reduction in ordering of low-value tests and procedures

1504:"Why 'Choosing Wisely' Won't Protect You in a Lawsuit" 170:

Dr. Wendy Levinson at launch of Choosing Wisely Canada

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Society of Obstetricians and Gynaecologists of Canada

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as one of the top medical breakthroughs of the year.

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Canadian Society of Allergy and Clinical Immunology

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Canadian Academy of Child and Adolescent Psychiatry

611:and Choosing Wisely Canada recommends testing only 924:Royal College of Physicians and Surgeons of Canada 283: 1683: 1319: 1317: 1315: 1313: 853:Canadian Society of Endocrinology and Metabolism 745:Canadian Association for the Study of the Liver 739:Canadian Academy of Sport and Exercise Medicine 228:Wendy Levinson, chair of Choosing Wisely Canada 207:overuse, such as the analysis conducted by the 918:Canadian Association of Professors of Medicine 847:Canadian Society of Palliative Care Physicians 615:(TSH) levels rather than testing both TSH and 334:An editorial was written by Wendy Levinson in 1310: 900:Newfoundland and Labrador Medical Association 748:Canadian Association of Emergency Physicians 317:Each recommendation is supported by evidence 232:Choosing Wisely Canada is modeled after the 178:prescriptions for respiratory infections in 52:unnecessary tests, treatments and procedures 868:Occupational Medicine Specialists of Canada 757:Canadian Association of Medical Oncologists 710:Choosing Wisely Canada is supported by the 545:Journal of the American Medical Association 412:testing in women with early pregnancy loss. 1540: 1538: 1536: 1526: 1524: 1522: 1461:"Unnecessary Medical Tests Need a Rethink" 1380: 1378: 973: 971: 969: 967: 965: 963: 850:Canadian Society of Respiratory Therapists 769:Canadian Association of Radiation Oncology 763:Canadian Association of Pediatric Surgeons 563:Patient receptiveness to campaign messages 490:Institute for Clinical Evaluative Sciences 1356: 1354: 1352: 1350: 823:Canadian Society for Transfusion Medicine 619:(such as T4) for assessment of suspected 344: 213:Canadian Institute for Health Information 1368: 1366: 1144: 1142: 1140: 1138: 1136: 1134: 947:National Association of Federal Retirees 935:Canadian Association of Retired Teachers 760:Canadian Association of Nuclear Medicine 754:Canadian Association of General Surgeons 751:Canadian Association of Gastroenterology 736:Canadian Academy of Geriatric Psychiatry 287: 223: 18: 1657:Official Choosing Wisely Canada Website 1561:"CWC in North York General Hospital ED" 1555: 1553: 1551: 1533: 1519: 1375: 960: 501:Advisory Panel on Healthcare Innovation 1684: 1347: 1251: 1249: 1247: 1245: 1156: 1154: 938:Canadian Association of Social Workers 865:College of Family Physicians of Canada 820:Canadian Society for Surgical Oncology 1662:Official Choosing Wisely (US) Website 1438: 1363: 1131: 841:Canadian Society of Internal Medicine 838:Canadian Society of Hospital Medicine 832:Canadian Society of Clinical Chemists 826:Canadian Society for Vascular Surgery 1548: 835:Canadian Society of Echocardiography 772:Canadian Association of Radiologists 766:Canadian Association of Pathologists 325: 1242: 1151: 932:Canadian Arthritis Patient Alliance 921:Canadian Partnership Against Cancer 569:Implementation in medical education 242:American Board of Internal Medicine 13: 1613: 742:Canadian Anesthesiologists Society 16:Canadian health education campaign 14: 1713: 1650: 1593:"Choosing Wisely Canada Partners" 1439:Grant, Kelly (18 February 2014). 1100:Unnecessary Care in Canada | CIHI 817:Canadian Rheumatology Association 522:Canadian Broadcasting Corporation 424:cost-cutting or rationing measure 909:Saskatchewan Medical Association 814:Canadian Psychiatric Association 811:Canadian Pharmacists Association 802:Canadian Orthopaedic Association 781:Canadian Dermatology Association 449: 164: 1585: 1576: 1567: 1510: 1496: 1487: 1467: 1453: 1432: 1415: 1409:"Choosing Wisely to Avoid Harm" 1401: 1387: 1338: 1326: 1300: 1288: 1278: 1268: 1259: 1222: 1213: 1204: 1195: 1175: 1166: 1122: 1113: 1104: 1093: 1084: 1074: 1064: 862:Canadian Urological Association 775:Canadian Cardiovascular Society 284:Clinician Recommendations Lists 1055: 1046: 1037: 1027: 1018: 998: 989: 980: 844:Canadian Society of Nephrology 778:Canadian Critical Care Society 244:in the United States in 2012. 1: 1702:2014 establishments in Canada 954: 897:New Brunswick Medical Society 796:Canadian Neurological Society 416: 197:are unnecessary, and 28% of 151: 874:Trauma Association of Canada 720:Canadian Medical Association 609:American Thyroid Association 441: 292:CWC List Development Process 250:Canadian Medical Association 40:Canadian Medical Association 7: 903:Ontario Medical Association 882:Alberta Medical Association 805:Canadian Paediatric Society 799:Canadian Nurses Association 790:Canadian Hematology Society 784:Canadian Geriatrics Society 705: 613:Thyroid Stimulating Hormone 586:North York General Hospital 509:Minister of Health (Canada) 401:in men without symptoms of 361: 271: 10: 1718: 1697:Health education in Canada 906:Quebec Medical Association 219: 182:are inappropriate, 28% of 59:Canadian healthcare system 38:, in partnership with the 1667:Costs of Care Foundation 859:Canadian Thoracic Society 787:Canadian Headache Society 551: 448: 236:campaign launched by the 163: 158: 944:Gastrointestinal Society 605:Women's College Hospital 575:randomized control trial 499:The final report of the 468:Women's College Hospital 941:Consumer Reports Health 1672:The Do No Harm Project 894:Medical Society of PEI 856:Canadian Spine Society 632:Problem-Based Learning 607:(WCH) in Toronto. The 579:Université de Montréal 530:Choosing Wisely Canada 387:stress cardiac imaging 374:Don't perform routine 345:Other campaign avenues 293: 277:Choosing Wisely Canada 229: 78:Choosing Wisely Canada 67:Choosing Wisely Canada 28:Choosing Wisely Canada 24: 1677:Less is More Medicine 808:Canadian Pain Society 712:University of Toronto 628:University of Toronto 617:free thyroid hormones 385:Don't perform annual 291: 254:University of Toronto 227: 209:Institute of Medicine 48:University of Toronto 22: 716:Unity Health Toronto 590:Greater Toronto Area 204:patient satisfaction 199:bone mineral density 63:false positive tests 44:Unity Health Toronto 1483:. 27 December 2013. 891:Doctors Nova Scotia 597:quality improvement 1446:The Globe and Mail 1285:Nov;29(11):1361-8. 1188:2015-09-23 at the 1011:The Globe and Mail 718:(Toronto) and the 517:The Globe and Mail 476:Queen's University 399:serum testosterone 380:metastatic disease 294: 230: 25: 1545:Jun;174(6):890-8. 1238:. 10 August 2015. 528:, which heralded 460: 459: 326:Patient education 175: 174: 1709: 1692:Health campaigns 1608: 1607: 1605: 1604: 1595:. 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