Choosing Wisely in Endocrinology

Abstract

Choosing Wisely (CW) is a clinician-led campaign committed to help patients and medical practitioners to engage in conversations about unnecessary care. It has raised awareness of the problem of overuse or low-value interventions in diagnostic procedures and medical treatments. This international movement began in the United States in 2012 and in Canada in 2014. The campaign engages physicians and other health care professionals, including nursing, dentistry, lab medicine, and pharmacy among others. It also engages with medical students to help them establish good practices early in their careers. Nowadays, the campaign has spread over to 35 countries, including Brazil, Colombia, and Argentina, who joined in October 2023.

In Colombia, under the leadership of the Colombian Association of Scientific Societies (ACSC for its acronym in Spanish), 11 scientific societies, including ACE, have joined “Decisiones Acertadas” since its inception. The list of recommendations of unnecessary tests and medications that ACE has released supports strong evidence that low-value care may lead to adverse events or further testing, which may increase anxiety for patients and caregivers and increase the likelihood of false-positives or other preventable harms. For example, ACE recommends that Vitamin D levels should not be routinely ordered in the general population, because this measurement does not change management. Other recommendations relate to overuse of thyroid ultrasound, basal insulin measurement, and bone markers in osteoporosis as well as limiting the utility of prescribing Vitamin D to patients with specific risk factors of deficiency.