Choosing Wisely

Sometimes good medicine is about what not to do. Choosing Wisely® encourages patients to talk with their physicians about the necessity of various tests and procedures. The following guidance can help you talk to your physician, help you understand what questions to ask and what evidence your physician is using to best treat your individual condition.

Things physicians and patients should question

The more you know, the more prepared you will be to ask your physician questions, understand recommendations and weigh the pros and cons of treatment options—all of which add up to getting the right care to best treat your individual condition.

Choosing Wisely has enlisted more than 60 medical specialty societies to create lists of "Things Physicians and Patients Should Question," which provide specific evidence-based recommendations for conversations on the risks and benefits of various medical tests. To date, there are over 500 recommendations available.

Visit the Choosing Wisely website to find these recommendations, searchable by subject and keyword.

Five questions to ask your doctor

Want to ask your physician or health care provider about a test, diagnosis or treatment but don't know where to start? Choosing Wisely offers guidance to help you talk to your physician, such as what questions to ask and what evidence he/she is using to best treat your individual condition.

Our goal is to promote informed conversations between physician and patient and to encourage shared decision-making. These five questions may help guide the conversation for both the patient and the health care provider to ensure the right care is delivered at the right time:

1. Do I really need this test or procedure? Medical tests help you and your health care provider decide how to treat a problem. And medical procedures help to actually treat it.
   
   
2. What are the risks? Will there be side effects? What are the chances of getting results that aren't accurate? Could that lead to more testing or another procedure?
   
   
3. Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more.
   
   
4. What happens if I don't do anything? Ask if your condition might get worse—or better—if you don't have the test or procedure right away.
   
   
5. How much does it cost? Ask if there are less expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.

Click here to download a wallet card with the five questions to have handy at your next doctor visit.

View this video on how you can put the five questions to use during a visit with your doctor.

The following tools can help you integrate Choosing Wisely's evidence-based best practices into your practice or organization.

Choosing Wisely Action Manual

For physicians or other health care leaders struggling with how to integrate Choosing Wisely's evidence-based best practices into their practices or organizations, the Choosing Wisely Action Manual takes a step-by-step approach to making system-level changes. The manual was created by the Washington State Choosing Wisely Task Force, a group of more than 20 medical leaders from the largest health care organizations in the state. The task force is co-sponsored by the WSMA, the Washington Health Alliance and the Washington State Hospital Association.

Download the Choosing Wisely Action Manual

Measuring Choosing Wisely recommendations in Washington state

In 2014, the first statewide study in the nation to measure Choosing Wisely recommendations was published by the Washington Health Alliance in conjunction with the Washington State Choosing Wisely Task Force. The study, based upon claims data representing 3.3 million lives in Washington state, finds that patients in Washington may be exposed to care that they don't need—and potential harm. A second report, published in 2016, showed improvement on six recommendations. The reports offer county-by-county results for nine different Choosing Wisely recommendations, and are based on the Choosing Wisely Claims-Based Technical Specifications (email jessica@wsma.org to request a copy).

Less waste. Less harm. Choosing Wisely in Washington state, September 2014
Less waste. Less harm. Choosing Wisely in Washington state, August 2016
First Do No Harm: Calculating Health Care Waste in Washington State, February 2018
First Do No Harm: Calculating Health Care Waste in Washington State, December 2018

Help us spread the word

• Choosing Wisely PowerPoint presentation template (for modification)

Drop the pre-op!

Physicians agree: All patients need pre-op evaluation, but a low-risk patient having a low-risk procedure does not need pre-op testing. Providing high-quality care to patients includes eliminating unnecessary tests, treatments and procedures. Based on results from the 2018 "First Do No Harm" report, the Washington State Choosing Wisely Task Force focused efforts on unnecessary pre-op testing and developed resources you can use to improve your practice and educate your colleagues.

• Drop the pre-op! Info sheet
• Drop the pre-op! PowerPoint presentation template (long version)
• Drop the pre-op! PowerPoint presentation template (short version)
• Drop the pre-op! Sample newsletter article

"5 Questions" poster for your exam or waiting room

The "5 Questions to Ask Your Doctor Before You Get Any Test, Treatment or Procedure" single-page flyer is a simple and effective way to encourage shared decision making. Post one in your exam room, or have them available in your waiting room. Any one of these five questions can help start the conversation for both the patient and physician to ensure the right care is delivered at the right time:

1. Do I really need this test or procedure?
2. What are the risks?
3. Are there simpler, safer options?
4. What happens if I don't do anything?
5. How much does it cost?

Download the 5 Questions poster

Web-based education for physicians

Interactive instructional modules, based on specialty society recommendations from the Choosing Wisely campaign, are available. By completing the modules, physicians will learn strategies to build trust and address patient attitudes and beliefs.

Access the modules here.

The resources below can help prepare care teams in primary care, specialty care, urgent care and school-based clinics.

Primary care, specialty care and school-based clinics

Preparing care teams to have the conversation

• Department chiefs and clinic managers can use sample email to educate staff about the Choosing Wisely campaign and inform them of what information patients will receive.
• The communications team can use sample text to educate staff and patients via posts on the Intranet and newsletters.

Pre-visit

• Send appropriate flyer (e.g. headaches, respiratory infections and pap tests) to patient based on their reason for visit. Send via email, text secure message or letter before the visit (e.g. when visit is scheduled or via electronic appointment reminder).

Checking in

• Give appropriate flyer (e.g. headaches, respiratory infections and pap tests) to patient based on reason for visit when checking in for appointment.
• Develop prompts for appointing staff to know when patient should receive Choosing Wisely information, using tips for targeting communications.

Rooming

• Staff give patient flyer (e.g. headaches, respiratory infections and pap tests) to read while waiting for physician, if patient didn't receive it at check-in.
• Build reminders into work flow to help staff remember to give flyer.

Exam

• Build alerts into EMR to remind physician of the Choosing Wisely recommendations.
• Place posters, flyers, rack cards and/or wallet cards in exam rooms so they are visible to physicians and patients.
• Physician gives patient flyer (e.g. headaches, respiratory infections and pap tests) and reviews key talking points.

Ongoing awareness

• Place posters and flyers in waiting rooms and exam rooms.
• Show videos on TV or iPads in waiting rooms.
• Include articles about local and national Choosing Wisely efforts in your organization's newsletters.
• School-based clinics: use communications tools.
• Post on social media using "#ChoosingWisely".

Urgent care

Preparing care teams to have the conversation

• Department chiefs and clinic managers can use sample email to educate staff about the Choosing Wisely campaign and inform them of what information patients will receive. Link to Choosing Wisely videos.
• The communications team can use sample text to educate staff and patients via posts on the Intranet and newsletters.

Checking in

• Give flyer to patient when checking in for appointment (e.g. headaches and respiratory infections).
• Develop prompts for staff to know when patient should receive Choosing Wisely information, using tips for targeting communication.

Rooming

• Build EMR or paper-based prompts to check that patient received flyer in waiting room.

Exam

• Build alerts into EMR to remind physician of Choosing Wisely recommendations.
• Place posters in exam rooms so they are visible to physicians and patients.
• Physician gives patient flyer (e.g. headaches and respiratory infections) and reviews key talking points.

Ongoing awareness

• Place posters and flyers in waiting rooms and exam rooms.
• Show a patient education video on TVs or iPads in waiting rooms.
• Include articles about local and national Choosing Wisely efforts in your organization's newsletters.
• Post on social media using "#ChoosingWisely".