JAY SIWEK, MD, Georgetown University Medical Center, Washington, DC

Published ahead of print June 18, 2012 

Sometimes, the hardest thing for a physician to do is nothing: not ordering magnetic resonance imaging for a patient with acute, uncomplicated back pain; not prescribing antibiotics for a simple upper respiratory tract infection; not reaching for the prescription pad when patients—exhorted by a television advertisement—ask if some new medicine is “right for them.” And although patients are sometimes a source of excess utilization, physicians, responding to conventional practices, current fads, and the rituals of medicine, often order tests or treatments that don’t stand up to clinical scrutiny. How do we do better? How do we know not only what to do, but alsowhat not to do?

For years, we’ve had the benefit of practice guidelines, although these tend to focus mainly on what to do. A new program, the Choosing Wisely campaign…

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