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Changing Clinician Behavior When Less Is More.

The American Board of Internal Medicine Foundation intended for the Choosing Wisely campaign to support conversations between clinicians and their patients about what care is necessary.1 The campaign sought to do so by involving professional societies in creating lists of unnecessary tests and procedures and disseminating the lists to their membership. At the same time, the campaign partnered with Consumer Reports to produce consumer-friendly briefs of Choosing Wisely recommendations and to disseminate the briefs to consumers. It remains an open question whether clinicians or consumers at large are aware of specific Choosing Wisely recommendations or have changed their attitudes toward unnecessary procedures and tests. In this study by Rosenberg and colleagues,2 the authors find little change in test and drug ordering by clinicians across a variety of target areas identified by the Choosing Wisely campaign based on commercial insurance claims for 1 or more years following publication of the Choosing Wisely list in April 2012. Appropriately, the authors cite substantial limitations that could obscure some modest impact of this campaign, particularly the challenge with claims data in defining the specific patient population to which a given lowvalue test or drug treatment applies. If we accept that the results are true, what lessons can we derive from this finding, and what next steps can be taken to help achieve the goals of the Choosing Wisely campaign? Even when dissemination efforts are successful, it is generally acknowledged that awareness of guidelines or healthrelated information is insufficient to change clinician or patient behavior, respectively. We focus the rest of our comments on changing clinician behavior (similar concepts apply to changing patient behavior). Although there is no “magic bullet,” sustained clinician behavior change generally requires multilevel and multifaceted strategies. It follows that the Choosing Wisely recommendations—even though created and distributed by trusted professional societies—are only a starting point. To actually reduce wasteful medical practices, delivery systems and clinician groups must (1) accept and commit to the Choosing Wisely challenge and (2) develop and implement strategies that make it easier for clinicians to follow Choosing Wisely recommendations.