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Response to ‘Choosing Wisely should bring the cost of unnecessary care back into the discussion’; Choosing Wisely’: a growing international campaign
  1. Karen B Born1,
  2. Wendy Levinson2
  1. 1 Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario
  2. 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Wendy Levinson, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B1W8; wendy.levinson{at}

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There are now approximately 20 countries worldwide that have launched or are in the process of launching Choosing Wisely campaigns.

As Haverkamp and colleagues have identified,1 Choosing Wisely campaigns have galvanised physicians worldwide to acknowledge their collective responsibility in reducing overuse and reducing harm associated with unnecessary care. And yes, cost is a tension in the campaign, and it would be naïve to say it is not a consideration. However, we maintain that in order to engage physicians in reducing unnecessary care, the focus cannot be on costs, but rather on reducing unnecessary care at each clinical encounter to improve quality and avoid harm.

Physicians' clinical decisions are largely responsible for unsustainable healthcare spending and the great deal of waste we see in healthcare systems worldwide. However, research highlights that physicians struggle with the acceptability of efforts to curb healthcare costs by influencing how they deliver direct patient care.2 Efforts to ‘ration’ patient care at the bedside are viewed with derision by practising physicians who are concerned primarily with patient outcomes …

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  • Competing interests None declared.

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

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