Choosing Wisely: fewer tests, better care
Choosing Wisely is a campaign that encourages clinicians and patients to talk openly about medical tests, treatments and procedures that are commonly used but often unnecessary, so that care that adds no value can be avoided. It began in 2012 when the ABIM Foundation, a United States medical charity linked to the American Board of Internal Medicine, invited specialty societies to name the things doctors and patients should question. The idea proved durable and portable, and versions of the campaign now run in more than twenty countries. This page describes that campaign neutrally; it is a reference, not medical advice, and it is not affiliated with any organizer or prior owner of this domain.
What the Choosing Wisely campaign is
The campaign rests on a simple observation: a meaningful share of everyday medicine is low value, meaning it is unlikely to help and may cause harm, waste or worry. Rather than issue rules from the outside, Choosing Wisely asked the specialties themselves to identify their own overused practices. National medical societies, from cardiology to oncology to emergency medicine, each drew up short lists of tests and treatments to reconsider. Because the recommendations come from within each field, they carry professional credibility and are hard to dismiss as external interference.
Choosing Wisely is best understood as a conversation-starter rather than a mandate. It does not ban anything. Its lists are framed as things to question and discuss, leaving room for the individual judgment of a clinician who knows the patient. That framing is deliberate, because the goal is better decisions, not blanket restriction.
How the lists of “things to question” work
The signature output of Choosing Wisely is the specialty list, usually a set of five recommendations, each naming a specific practice that should not be done routinely and explaining why. A recommendation typically pairs a plain instruction with the evidence behind it. Recurring themes across specialties include:
- Avoiding imaging, such as scans for uncomplicated low back pain or headache, when there are no warning signs, because the findings rarely change treatment and can trigger further tests.
- Not prescribing antibiotics for viral infections, where they cannot help and drive resistance.
- Reconsidering routine pre-operative testing in healthy patients before low-risk surgery.
- Questioning cancer screening at ages or intervals where the balance of benefit and harm turns unfavorable, an especially debated example being some breast and prostate screening recommendations.
- Reviewing long-term medications, such as sedatives in older adults, where the risks quietly outgrow the benefits.
The lists are living documents. Societies revise and retire recommendations as evidence changes, and the collection now spans hundreds of individual items across dozens of specialties. Hospitals and health systems increasingly build these recommendations into their internal guidelines, order sets and quality programs, so that the default option nudges toward the higher-value choice.
Choosing Wisely Canada and other national programs
Among the international offshoots, Choosing Wisely Canada is one of the most developed. It is a national campaign, coordinated with Canadian medical faculties and specialty societies, that produces its own lists of Canadian recommendations tailored to Canadian practice, from primary care to hospital and critical care settings. It publishes clinician toolkits, patient-facing materials, and guidance for reducing specific low-value practices in hospitals. Similar national campaigns operate elsewhere, each adapting the core method to its own health system while sharing the underlying philosophy. The existence of these parallel programs, developed independently in different countries, is part of why the movement is taken seriously rather than treated as a single institution’s opinion.
The four questions patients can ask
Choosing Wisely also gives patients a compact tool for the consulting room. Before agreeing to a test, treatment or procedure, a patient can ask their clinician a short set of questions designed to surface the trade-offs:
- Do I really need this test or procedure? Tests should help clarify what is happening or guide treatment.
- What are the risks and downsides? These range from side effects and follow-up tests to the chance of a false alarm.
- Are there simpler, safer options? Sometimes watchful waiting or a change in habits is a reasonable alternative.
- What happens if I do nothing? Many conditions improve on their own or stay stable, so understanding the “wait and see” path is part of an informed choice.
These questions are not a script for refusing care. They are a way of making the reasoning explicit, so that a decision to proceed is a genuinely informed one and a decision to hold off is equally deliberate. They pair naturally with the practice of shared decision-making, in which the patient’s own priorities help settle the choice, and with the wider philosophy set out in the case for less medicine.
Where Choosing Wisely fits
Choosing Wisely is one strand in a broader effort to reduce over-testing and over-treatment. It provides the practical, specialty-endorsed lists; the ethical framing it draws on is captured by quaternary prevention, the deliberate protection of patients from unnecessary medicine. Together they push against the tendency for ordinary variation and mere risk to be managed as disease, a drift that also shows up in the marketing of lifestyle drugs that treat features of everyday life rather than illness.
The measure of the campaign’s success is not how many tests are cut, but whether the tests and treatments that remain are the ones that genuinely improve people’s lives. Choosing Wisely reframes the question every clinician and patient faces from “is there anything more we could do?” to “is this the right thing to do?” That shift, repeated across millions of encounters, is the quiet work of choosing wisely.