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Engaging patients and the public in Choosing Wisely
  1. Karen B Born1,2,
  2. Angela Coulter3,
  3. Angela Han4,
  4. Moriah Ellen1,5,
  5. Wilco Peul6,
  6. Paul Myres7,
  7. Robyn Lindner8,
  8. Daniel Wolfson9,
  9. R. Sacha Bhatia10,11,
  10. Wendy Levinson2,10
  1. 1 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  2. 2 St. Michael's Hospital, Toronto, Ontario, Canada
  3. 3 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  4. 4 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Jerusalem College of Technology, Yerushalayim, Israel
  6. 6 Universiteit van Amsterdam, Amsterdam, The Netherlands
  7. 7 Academy of Medical Royal Colleges, Cardiff, Wales
  8. 8 NPS Medicine Wise, New South Wales, Australia
  9. 9 ABIM Foundation, Philadelphia, Pennsylvania, USA
  10. 10 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  11. 11 Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Karen B Born, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street West, Suite 425, Toronto, ON M5T 3M6, Canada; karen.born{at}

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Why patient and public engagement is important for tackling overuse

Choosing Wisely campaigns aim to engage physicians and the public in tackling the problem of overuse in medicine.1 Choosing Wisely has been adopted by medical and other clinician societies worldwide, having now spread to approximately 20 countries. While physicians have demonstrated a high degree of interest, engaging patients and building wider public awareness is far more challenging. The belief that more testing and more treatment lead to better outcomes is widespread, and physicians rarely discuss the risks and harms of overuse with patients.2–4 Indeed, there is a marked tendency among both patients and physicians to overestimate the benefits of medical interventions and underestimate harms.5 Further, physicians’ perceptions of the unacceptability to patients of applying Choosing Wisely recommendations appear to be a major barrier towards implementation.6 There is concern that the impact of campaigns will be blunted if patients and the broader public are not receptive to the message of Choosing Wisely. Evidence demonstrates that up to 30% of all medical care adds no value to patients, and in fact can lead to harm.7 Yet, overuse persists as both clinicians and patients are victims of the ‘therapeutic illusion.’8 Choosing Wisely campaigns attempt to tackle this problem through establishing specialty-specific lists of recommendations of ‘Things Clinicians and Patients Should Question.’ A central goal of Choosing Wisely campaigns is to change patient and public knowledge and attitudes, in addition to physician practice, in order to influence the culture of medicine that has driven overuse.1

Patient and public expectations are often cited by physicians as a major cause of overuse, although the extent to whether this is true is unclear.9 The concepts of overdiagnosis, overtreatment and overuse can be confusing for laypeople, yet the consequences are serious to individuals through harm, and to society through diversion …

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  • Contributors KBB, AC, WL and AH developed the initial patient public engagement framework. KBB drafted and revised the manuscript. AC and WL substantially revised the manuscript. ME, WP, PM, RL, RSB and DW all provided substantive comments and suggested revisions for the framework manuscript. All members of the Choosing Wisely International Working Group discussed the contents of the framework.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.