Be Wise When Choosing Wisely

Matthew L. Mintz, MD


March 20, 2013

In This Article

Empowering or Confusing Patients?

Many of the major media outlets have sensationalized and oversimplified the Choosing Wisely program, portraying it as a new directive for doctors.

The New York Times described it as a list of don'ts.

The Washington Post's headline read, Group releases list of 90 medical 'don'ts.'

NBC News explained to their audience, "You don't need an MRI for lower back pain. You don't need antibiotics for a sinus infection. And you don't need to be screened for osteoporosis, either, if you're under 65."

So it should not surprise us when a patient such as Mrs. Jones, or any patient for that matter, declines tests or treatments that appear on the Choosing Wisely lists.

However, this is not what the experts recommended. Whereas the 90 items in question may be overused, they are not useless. There might very well be an occasion when the benefits of ordering CT after a child's minor head injury outweigh the very small potential increased risk for cancer from radiation exposure.

With regard to diabetes, the American Diabetes Association does an excellent job of providing guidance on an individualized approach to glycemic control that takes the patient's age into consideration, along with such factors as patient attitudes, resources, and comorbidities. This is very different from a "never" interpretation of the Choosing Wisely recommendations.