Chapter 1 10 “Do as much as possible for the patient, and as little as possible to the patient.” - Dr. Bernard Lown Choosing Wisely Healthcare costs rise every year. Discussions on this subject tend to focus on the balance between best individual patient care versus reducing the public healthcare related costs. This balancing suggests that reducing costs goes at the expense of good patient care. But more care is not always better care. Overuse of medical resources is not only a factor in health care spending, but also puts patients at risk of harm (1). It is well known that care can cause unintentional harm, such as radiation exposure, adverse drug reactions, complications or errors during procedures, unnecessary follow-up tests, and patient concern. When the care has (potential) benefit, this can outweigh the (potential) risk of harm. However, when this care is not clinically indicated, no potential benefit is present, leaving only the risks of harm. Estimates suggest that as much as 30% of all health care spending is unnecessary and does not add value in care (2–4). Choosing Wisely is a campaign initiative to reduce potential harm and costs of care. The American Board of Internal Medicine Foundation (ABIM-F) started this campaign in partnership with Consumer Reports to stimulate a conversation between physicians and patients about avoiding wasteful, unnecessary medical tests, treatments, and procedures. The focus is on value of care and potential risks for the patient, rather than using costs as the motivating factor (5,6). Since physicians’ decisions account for about 80% of health care expenditures, they need to play a leading role in reducing unnecessary tests and procedures. The Choosing Wisely campaign is now spread worldwide to more than 20 countries, including the Netherlands since 2013 (6–9). In 2014, the Dutch Association of Internal Medicine (NIV) also committed to create a list of recommendations for internal medicine. Internal medicine is a broad and diverse specialism. In the Netherlands, the NIV has 14 subspecialties, all with their own societies. Despite this diversity, the working group for the development of the Wise Choices in Internal Medicine was able to formulate 10 evidence-based recommendations, with the support of all subspecialty societies and national patient federation. One of these ‘Wise Choices’ was:
RkJQdWJsaXNoZXIy MTk4NDMw