Ellen and colleagues argue that expanding the geographical and professional reach and thematic scope of choosing wisely could help achieve greater impact

Choosing wisely (CW) is a campaign for healthcare professionals and patients to engage in conversations about unnecessary tests, treatments and procedures, and to help them make smart and effective choices to ensure high-quality care.1 Through this partnership, national organisations representing medical specialists identify tests or procedures commonly used in their field whose necessity should be questioned and discussed. A successful decade has passed since CW recommendation ‘five things to question’ lists were first published in the USA in 2012 based on the input of 9 different medical societies.2 3 The past decade has included a plethora of accomplishments, including the internationalisation and local adaptation of the campaign in countries such as Canada, the Netherlands, Australia, New Zealand, Israel and the UK, as well as the successful implementation of various recommendations, for example, reducing unnecessary blood chemistry testing in the emergency department or reducing unnecessary antibiotic prescribing and antipsychotics use.4 5

Potential harms of overuse for patients include overdiagnosis,6 overtreatment,7 antibiotic resistance8 and radiation exposure.9 Up until now, the emphasis of many campaigns has been to raise awareness about overuse as an important problem to address. The majority of the effort has targeted physician organisations that create the lists. Furthermore, efforts to implement the recommendations are just in the early stages, often single-site studies, or unpublished. Evidence for impact of the CW campaigns is just emerging. These challenges are consistent with a young campaign, but we see opportunities for greater impact as CW matures.

We propose two main areas of expansion. First, broadening collaborations: both in existing campaigns, by including other stakeholder groups, and in developing new campaigns in low-income and middle-income countries (LMICs), which account for the majority of the global health population. Second, expanding CW a step beyond a clinical approach focused …