Weeks When Decades Happen
May 28, 2012

Referring to the Russian Revolution, Lenin once said that "there are decades when nothing happens and there are weeks when decades happen". We are living in one of those periods with momentous change occurring quickly in the structure and power relationships within North American health care. For the first time we have organized medicine cautiously making public the fact that an important percentage of health care interventions are not in the patients' interests. This phenomenon, termed Choosing Wisely, is organized by the American Board of Internal Medicine Foundation. All the medical specialties were invited to list up to five interventions (test, procedures, drugs) in their area with little or no benefit to patients. Not all specialties participated, but enough did to indicate the breadth of possible increased safety, efficiency and lower costs. Well done; keep it up! One or two suggestions for improvement: make the criteria public for the choices and involve patients in a meaningful way in these considerations. We all need to participate in changing that ‘doctor knows best' passivity. What we don't know will make us sicker, poorer and maybe kill us.