TY - JOUR T1 - Response to ‘Choosing Wisely should bring the cost of unnecessary care back into the discussion’; Choosing Wisely’: a growing international campaign JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 777 LP - 778 DO - 10.1136/bmjqs-2017-006588 VL - 26 IS - 9 AU - Karen B Born AU - Wendy Levinson Y1 - 2017/09/01 UR - http://qualitysafety.bmj.com/content/26/9/777.abstract N2 - 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 … ER -