In the Spirit of Choosing Wisely

There’s a moment in almost every doctor’s visit when someone (patient, clinician, or the voice in your head that sounds suspiciously like your
group chat) thinks: “Shouldn’t we just… do a test?” An X-ray. A blood panel the size of a phone book. An MRI “just to be safe.”
A medication “in case it helps.” It feels proactive. Responsible. Very do-something.

But sometimes doing more doesn’t mean getting better care. Sometimes it means more false alarms, more side effects, more bills, and more
time spent chasing problems that weren’t actually problems. That’s the heartbeat behind Choosing Wiselya health care mindset
(and national campaign) that encourages patients and clinicians to pause, talk, and pick care that’s truly necessary: evidence-based, non-duplicative,
and as free from harm as possible.

This isn’t a “never test, never treat” philosophy. It’s a “let’s be smart before we press the big red button” philosophy. Think of it like
checking whether the smoke alarm needs new batteries before calling the fire department.

What “Choosing Wisely” Means (In Plain American English)

Choosing Wisely is best understood as a commitment to right-sized care: not too much, not too littlejust what helps. In practice,
it encourages clinicians and patients to have honest conversations about tests, treatments, and procedures that are commonly used but may be
unnecessary in certain situations.

Unnecessary care isn’t just expensivealthough it can be. It can also be risky. A test can lead to an “incidental finding” (translation: a surprise
that looks scary but isn’t), which can trigger more scans, biopsies, anxiety, and sometimes complications. A medication can cause side effects that
feel worse than the original issue. A procedure can be appropriate for one person and overkill for another.

The spirit of Choosing Wisely is simple: before you do something, ask whether doing it improves outcomesand whether the possible
harms outweigh the benefits for this particular person, right now.

Why Overuse Happens (Even When Everyone Means Well)

If clinicians and patients generally want what’s best, why do unnecessary tests and low-value treatments happen at all? Because health care is a
perfect storm of good intentions, uncertainty, and “what if” thinking.

1) Fear of missing something

Medicine deals in probabilities, not guarantees. When symptoms are vague (fatigue, back pain, headaches), it’s tempting to order “everything” to
rule out rare but serious conditions. The problem is that broad testing also increases the chance of misleading results.

2) More information feels like more safety

In normal life, more information usually helps. In medicine, more information can be noisy. Some findings are common in healthy peoplelike minor
spine changes on imagingand can lead to treatments that don’t improve pain or function.

3) Time pressure

A thoughtful conversation can take longer than clicking “order labs.” Choosing Wisely tries to bring the conversation backeven when schedules are tight.

4) The “patient asked for it” myth (and the reality)

Sometimes patients do ask for tests. But many patients mainly want reassurance, clarity, and a plan. When clinicians explain why a test is unlikely
to help (and what to watch for instead), a lot of people feel relievednot dismissed.

The Hidden Downsides of “Just in Case” Medicine

Here’s the part nobody puts on a billboard: a medical test can be the first domino in a chain reaction. Sometimes that chain leads to a lifesaving
diagnosis. Other times it leads to a frustrating, expensive scavenger hunt.

False positives and the anxiety tax

A “positive” result doesn’t always mean disease. It can mean an abnormality that never would have caused harm. But once it’s on paper, it’s hard
to un-see. This is why Choosing Wisely emphasizes using tests when results will actually change management.

Incidental findings

Advanced imaging is powerfuland a little too good at finding harmless quirks. A tiny cyst. A benign nodule. A variation in anatomy that has been
quietly minding its business for years. Incidental findings can lead to more tests and procedures that carry real risks.

Overtreatment

Treating something that doesn’t need treatment can cause more harm than help. The classic example: prescribing antibiotics for viral infections.
Antibiotics don’t help viruses, but they can cause side effects and contribute to antibiotic resistance.

Choosing Wisely in Action: Common, Concrete Examples

Choosing Wisely recommendations vary by specialty, but many focus on common scenarios where “more” doesn’t improve outcomes. Here are a few
practical examples that show the mindset.

Example 1: Imaging for low back pain (when there are no red flags)

Low back pain is incredibly commonand incredibly miserable. When you’re hurting, it feels logical to get an MRI immediately to “see what’s going on.”
But for many people with new, non-specific back pain, early imaging doesn’t improve outcomes. It can, however, uncover normal age-related changes that
sound alarming and lead to unnecessary procedures.

The Choosing Wisely approach: focus first on history, physical exam, symptom management, and timewhile staying alert for red flags
(for example: severe or progressive neurologic deficits, certain infection signs, major trauma, or suspicion for serious underlying causes). If red flags
are present, imaging may be appropriate sooner.

Example 2: Antibiotics for colds, flu, and most bronchitis

Antibiotics feel like “doing something,” but they don’t treat viruses. For viral respiratory illnesses, the best care is usually supportive:
rest, fluids, symptom relief, and guidance on when to come back if things worsen. Choosing Wisely recommendations frequently emphasize avoiding
antibiotics when the likelihood of bacterial infection is low.

Example 3: Blood transfusions “to be safe” instead of “as needed”

In some situations, transfusions are lifesaving. In others, a more conservative approach (using the minimum necessary units to relieve symptoms and
maintain safe levels) can be safer and just as effective. The Choosing Wisely mindset pushes clinicians to match intensity of care to the evidence and
the patient’s condition.

Example 4: Cancer care that doesn’t match goals or likelihood of benefit

Some specialty recommendations highlight situations where treatments are unlikely to provide benefitespecially when the burdens of therapy are high.
Choosing Wisely doesn’t replace personalized oncology care; it supports thoughtful discussions about outcomes, quality of life, and patient goals.

Example 5: Specialty-specific “don’t routine” lists

Across fieldsfrom emergency medicine to surgery to hematologyChoosing Wisely recommendations often target routine practices that became habitual
over time. The point isn’t to shame anyone. It’s to update habits with evidence and reduce avoidable harm.

The Five Questions Mindset: A Mini Script You Can Actually Use

Choosing Wisely popularized a patient-friendly way to start the conversation. You don’t need medical vocabulary. You need curiosity and the courage to
be politely persistent. Here’s a practical set of questions (paraphrased) that can help:

• Do I really need this test or treatment? What problem are we trying to solve?
• What are the risks or downsides? Side effects, false alarms, complications, costs.
• Are there simpler or safer options? Watchful waiting, lifestyle changes, physical therapy, symptom care.
• What happens if I do nothing for now? What should I watch for?
• What will this cost me? Out-of-pocket costs and time costs both count.

The goal is not to “catch” your clinician in a bad idea. The goal is to make sure the plan fits the evidence and your life.

Choosing Wisely as a Clinician: It’s Not Just Saying “No”

For clinicians, Choosing Wisely isn’t about denying care. It’s about improving the match between care and benefit. That takes skill:
explaining uncertainty, setting expectations, and offering a plan that feels supportive.

Replace “no” with “here’s what we do instead”

Patients don’t like being waved off. They do like having a roadmap. A Choosing Wisely conversation often works best when it includes:
(1) why the test is unlikely to help now, (2) what the evidence suggests, (3) what symptoms would change the plan, and (4) what supportive care or
follow-up will happen next.

Make room for shared decision-making

Some decisions are preference-sensitive. Two reasonable options may exist, and what matters most is the patient’s goals and tolerance for risk.
Choosing Wisely encourages those conversationsespecially when “routine” care isn’t clearly beneficial.

Where Choosing Wisely Can Be Tricky (And How to Think About It)

No campaign is magic. Choosing Wisely is widely respected, but it has limitationsand it’s honest about the complexity of changing medical practice.

Guidelines aren’t one-size-fits-all

A recommendation applies to many people, not every person. Context matters: age, comorbidities, symptom severity, history, and patient preferences.
Choosing Wisely is a conversation starter, not a final verdict.

Underuse exists, too

“Do less” is not always the answer. Some communities face barriers to needed carepreventive services, timely diagnoses, or effective treatments.
The spirit of Choosing Wisely is “do what helps,” which includes doing more when evidence shows it improves outcomes.

Implementation is the hard part

Lists are easy. Changing habits, payment incentives, workflows, and expectations is harder. Many health systems work on decision-support tools,
clinician education, and patient materials to make high-value care easier to deliver.

How to Use Choosing Wisely Without Becoming “That Person”

You can bring Choosing Wisely into real life without turning every appointment into a courtroom drama. Try this approach:

1. Start with your goal. “I want to understand what’s causing this and what our plan is.”
2. Ask one or two of the key questions. Pick the ones that matter most in the moment.
3. Invite the clinician’s reasoning. “What would this test change about what we do next?”
4. Agree on a safety net. “What symptoms mean I should contact you sooner?”
5. Document the plan. A simple after-visit summary can reduce anxiety later.

Bonus tip: if you feel awkward asking about cost, remember that “cost” includes missed work, childcare, travel, and time.
That’s not being difficultthat’s being realistic.

Bottom Line: Choosing Wisely Is a Culture, Not a Checklist

In the spirit of Choosing Wisely, the win is not “fewer tests.” The win is better decisions. The win is care that’s aligned with
evidence, your goals, and the realities of risk. The win is fewer medical wild goose chasesand more time and resources spent where they truly help.

If you take one idea from this article, make it this: when a test or treatment is offered (or requested), it’s fair to ask,
“How will this change what we do next?” That question is a flashlight in the fog. It won’t solve everything, but it will keep you from
walking into a ditch just because everyone else is jogging that direction.

Important: This article is for general educational purposes and is not a substitute for medical advice. If you have urgent symptoms or concerns, contact a licensed clinician or emergency services.

Real-World Experiences in the Choosing Wisely Spirit (Composite Stories)

The best way to understand Choosing Wisely is to see what it looks like in ordinary lifemessy schedules, worried families, and symptoms that refuse
to behave like textbook examples. The experiences below are composite scenarios inspired by common situations in U.S. health care.
They’re not about “perfect patients” or “perfect doctors.” They’re about better conversations.

1) The Back Pain MRI That Turned Into a Detour

A middle-aged office worker strains their back moving a couch (the couch, of course, is fine). The pain is real, and sleep is suddenly an extreme sport.
They ask for an MRI immediately, worried about a “slipped disc.” The clinician explains that most new back pain improves with time, movement as tolerated,
and targeted therapyand that early imaging can find age-related changes that sound scary but don’t predict pain. Together they choose a plan:
pain control, gentle activity, physical therapy, and a clear list of red flags that would trigger imaging sooner. Two weeks later, pain is improving.
No MRI. No incidental finding. No cascade. Just a solid plan and a little patience (the hardest medication to swallow).

2) The “Just Give Me Antibiotics” Cold

A parent brings in a teen with congestion, sore throat, and a nasty cough that sounds like it was recorded for a horror movie trailer.
The family asks for antibiotics because “last time it helped.” The clinician walks through what’s likely viral, what signs would point to bacterial
infection, and what supportive care actually helps. They discuss downsides: side effects, upset stomach, and antibiotic resistance. The clinician doesn’t
just say “no”they give a practical plan: hydration, rest, symptom relief options, and a timeline for when to check back if symptoms worsen or persist.
The family leaves with reassurance and instructions, not antibiotics. The teen recovers. The parent texts a friend: “We didn’t get antibiotics…
and honestly, that made sense?”

3) The Lab Panel That Wasn’t a Treasure Map

An adult feels tired for months and requests “a full blood workupeverything.” The clinician acknowledges the frustration (chronic fatigue is the worst
kind of vague) and explains that very broad panels can uncover minor abnormalities that don’t explain symptoms but do create worry. Instead, they build
a targeted approach: history, sleep evaluation, mood screening, medication review, and a limited set of labs based on risk factors and symptoms.
The patient feels heard because the conversation is thorough. The testing is thoughtful. They don’t catch a “rare zebra,” but they do identify a
sleep issue and a medication side effect that together explain a lot. The plan becomes actionable instead of scattershot.

4) The “Do Everything” Moment in Serious Illness

A family faces an advanced cancer diagnosis. Everyone wants to fight, and “more treatment” can feel like “more love.” The oncology team uses a Choosing
Wisely-informed approach to discuss what additional therapy can and can’t realistically do in this situation. They talk about benefits, burdens, and
what the patient values mostmore time at home, symptom control, being alert for family milestones. Instead of a default escalation, the plan becomes
personalized: targeted symptom management, careful consideration of any therapy with meaningful likelihood of benefit, and early palliative support.
The family doesn’t feel like they “gave up.” They feel like they chose a path that matched the patient’s goals.

5) The ER Visit Where “More Tests” Wasn’t the Kindest Option

An anxious patient arrives at the emergency department with chest discomfort after a stressful week and little sleep. The clinician takes it seriously,
evaluates risk, and orders appropriate tests. But when results and exam suggest low risk for dangerous causes, the clinician explains why “one more scan”
is unlikely to help and could expose the patient to unnecessary radiation, false positives, or incidental findings. They discuss follow-up and what
symptoms would require immediate return. The patient leaves without the “everything” workupbut with reassurance grounded in clinical reasoning and a
safety net plan. The real medicine here wasn’t the test. It was the explanation.

These experiences highlight the real secret sauce of Choosing Wisely: it’s not a refusal. It’s a relationship skill. It’s the ability to replace
anxiety-driven medicine with evidence-informed choices and a clear plan. When that happens, patients don’t feel shortchanged. They feel respected.
And that’s a kind of high-value care you can’t bill with a codebut it changes everything.