General Medicine
2015, vol. 16, no. 2, p. 61–62.
Editorials
Choosing Wisely International and Japan Yasuharu Tokuda, MD, MPH Editor-in-Chief, General Medicine
The 2nd International Roundtable on Choosing Wisely
2. Share successful strategies and challenges to
was held in the Royal College of Anesthesiology Building, London, UK, on May 28–29, 2015 (Figure 1).
implementing Choosing Wisely. 3. Discuss approaches to evaluation of the campaign
This event was followed by the first such conference
and collaborate on common measures of overuse.
1
held in Amsterdam, Netherland. Since I had fortunate opportunity to participate in the 2nd international con-
Representatives from 17 countries participated in this meeting including two Asian countries (Dr. Hyeong
ference by courtesy of Dr Shunzo Koizumi (one of the former editors-in-chief of this journal), I would like to
Sik Ahn, Professor, Korea University College of Medicine, South Korea, and me from Japan). We also
report this exciting forefront for developing a rare but precious international medical campaign by advancing
had attendance by Mr. Niek Klazinga, a representative from the Organization for Economic Co-operation and
medical professionalism to improve health care pro-
Development (OECD), the Commonwealth Fund and
fessionalism. The purposes of the meeting were to:
the Consumer reports, USA. Dr. Wendy Levinson, who is Chair of the Choosing Wisely Canada, organized this meeting highly interactive and conversational (Figure 2, 3).
1. Share the progress that countries have made in Choosing Wisely over the last year.
After identifying major challenges to the campaigns in Figure 1. The Royal College of Anesthesiology Building, London, UK
individual participating countries, Dr. Daniel Wolfson introduced underlying principles of Choosing Wisely and its application to recommendations development and implementation by citing Self-Determination Theory and Complexity Theory enhancing cultural shifts in a society. In his remark, the USA Consumer Reports was identified an example of emergence among phenomena described by the complexity theory, since the Consumer Report was not initially expected as a major participant but it now provides strong and important role as consumers’ organization including various patient support groups for this campaign.
Corresponding author: Yasuharu Tokuda, MD, MPH JCHO, Tokyo, Japan E-Mail:
[email protected] © 2015 The Japan Primary Care Association
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General Medicine
Figure 2. A scene of the meeting
2015, vol. 16, no. 2
Figure 3. Participants of the meeting
Figure 4. The workshop product of our discussion group
Table. Characteristics of Campaign Activities of Choosing Wisely USA and Canada Characteristic
Choosing Wisely USA
Choosing Wisely Canada
Starting year
2012
2014
Participating society
70 specialty societies
45 specialty societies
Recommendations
400
150
Patient pamphlet
90
25
Implementation
Organic and accelerated
Organic
Dr. Levinson and Mr. Tai Huynh, Choosing Wisely
to treat (NNT), which is calculated by 1/(absolute risk
Canada, showed their strategies and the challenges in their country compared to those in USA. Table shows
reduction). However, relative risk format misleads us to overestimate the treatment effect.2 Thus, we have
the most recent data showing campaign activities of
reached to conclude that medical journals should stop
Choosing Wisely USA and Canada. During the conference, we had open space session
using relative risk and start using absolute risk or NNT. In this journal, I should encourage clinical investigators
based on small group discussion for identifying issues and solutions related to choosing wisely campaign in
and educators to submit high-quality papers related to overuse of medical tests and interventions and also to
countries of participants. I had joined the discussion
provide their results data as absolute risk format to
group for issues about how to improve risk literacy among practicing physicians. In this discussion, we
follow the conclusion of our discussion group.
provided multiple examples of evidence showing how to improve health and risk literacy among physicians
References 1 Levinson W, Kallewaard M, Bhatia RS, Wolfson D,
(Figure 4).
Shortt S, Kerr EA: ‘Choosing Wisely’: a growing
One of these examples is a format in which randomized controlled trials or cohort studies present their results in
international campaign. BMJ Qual Saf. 2015;24(2): 167–174.
most medical journals. They usually present treatment effect as relative risk but adverse event rate as absolute
2 Bodemer N, Meder B, Gigerenzer G: Communicating Relative Risk Changes with Baseline Risk:
risk. Absolute risk is the preferred format for providing
Presentation Format and Numeracy Matter. Med Decis
clinically meaningful patient-centered information and this can be transformed easily into the number needed
Making. 2014;34(5):615–626.
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