The ABIM Foundation, a non-profit arm of the American Board of Internal Medicine established in 1999, has announced the creation of lists of tests, treatments, and drugs that patients should question. The ABIM has as its mission the advancement of professionalism among physicians. One way the foundation works to fulfill this mission is the "Choosing Wisely" campaign, which exhorts patients (as well as physicians) to think carefully about medical treatments before accepting (or performing) them.
At ChoosingWisely.org, the ABIM Foundation lists 30 release dates for tests and treatments to question; each list is developed by one or more medical professional associations. "Choosing Wisely is focused on encouraging physicians, patients, and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm," the Web site states. Consumer partners such as Consumer Reports and Wikipedia are assisting in the dissemination of these lists. Consumer Reports provides a master list -- which will be updated as more information becomes available -- on its outreach Web site here.
The American Psychiatric Association (APA) released its list on September 20, 2013. It is available here. All five treatments to question involve antipsychotic drugs. Item number two on the list is particularly chilling, given the low frequency with which the advice is followed: the APA cautions physicians, "Don't routinely prescribe two or more antipsychotic medications concurrently." However, the explanation for this tip expounds, "Use of two or more antipsychotic medications occurs in 4% to 35% of outpatients and 30% to 50% of inpatients." Equally disturbing is item number five, which advises, "Don't routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders," then notes that "Use of antipsychotic medication in children has nearly tripled in the past 10 to 15 years [...] Evidence for the efficacy and tolerability of antipsychotic medications in children and adolescents is inadequate." It seems that a large share of parents and doctors need a lesson in choosing wisely.