The “Choosing Wisely” initiative to reduce low value care: has endocrinology been wise enough?

Abstract

The challenges of practicing medicine manifest at multiple levels from the clinician–patient interaction to society. Among these are excess health care costs related to overuse and use of low-value care, services which do not provide benefits worth the cost. Physicians have a role as stewards of finite resources. The Choosing Wisely initiative seeks to address this issue and involves multiple professional societies. We describe the recommendations of the Endocrine Society and others as they apply to the practicing endocrinologist.

KEYWORDS:

• choosing wisely
• overuse
• low-value care

Financial & competing interests disclosure

The authors were supported by the Department of Veterans Affairs. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Healthcare delivery is plagued by use of unnecessary services, that is, overuse, the provision of health care services for which harms outweigh benefits to those who receive them.

• Overuse represents poor quality and contributes to high costs.

• De-implementation or de-adoption of outmoded or unnecessary services has proved to be difficult.

• The inclusion within the code of professionalism of responsibility for stewardship of societal resources has led to an initiative of professional societies to address overuse: Choosing Wisely.

• Endocrinology-related societies currently participating in the initiative are the Endocrine Society and the American Society for Reproductive Medicine.

• The five practices identified as low-value care by the Endocrine Society have strong evidence to support their inclusion, but other candidates with equally good or better support were omitted, for example, overtreatment of diabetes in specific populations.

• There is a need for a research agenda to address the many unknowns about overuse.

• The problem of overuse is likely to get worse.