To choose or not to choose: an update on the Choosing Wisely Canada campaign and emergency medicine recommendations

“To choose or not to choose”: an update on the Choosing Wisely Canada campaign and emergency medicine recommendations

Resident Clinical Pearl – April 2016

Kavish Chandra, R1 Family Medicine and Emergency Medicine, Dalhousie University


Reviewed by: Dr. David Lewis


Globally, healthcare costs have increased substantially. In Canada, healthcare expenditure was predicted to reach $219 billion in 2015, amounting to 10.9% of our gross domestic product.1 Perhaps more importantly, we do not see the same increase in the quality of healthcare, with Canada ranking 10 of out 11 among developed countries.2

As physicians, our knowledge of the costs of the tests and procedures we order are poor.3 The estimated cost of a single plain film X-ray is $33.76 and a 2-region CT scan is $133.63, which does not include the radiologists interpretation.3 Couple that with the risk associated with certain tests (invasive, radiation, false negatives and positives), we overuse certain tests and subject patients to risks that provide little value to their care.


The solution:

The Choosing Wisely campaign was launched by the American Board of Internal Medicine in 2012.4,5 Modelled after the U.S. Choosing Wisely campaign, Choosing Wisely Canada (CWC) is a national campaign aimed to help patients and physicians critically think about medical tests, treatments and procedures that were overused and provided little benefit to patients.6 Canadian medical speciality associations were asked to identify “5 things patients and physicians should question”.


The Canadian Association of Emergency Physicians (CAEP) and CWC developed the emergency medicine “5 things” 7


  1. Don’t order CT head scans in adults and children with minor head injuries (unless positive for a head injury clinical decision rule)
  2. Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis
  3. Don’t order lumbosacral spinal imaging in patients with non-traumatic low back pain who have no red flags
  4. Don’t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules
  5. Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses.


Please see the following link for a brief video of the SJRH Emergency Department Rounds presentation by Kavish Chandra



Please follow the link below more information on the Choosing Wisely Canada campaign and the emergency medicine recommendations





  1. Canadian Institute for Health Information. National Health Expenditure Trends, 1975 to 2015. Ottawa, ON: CIHI; 2015
  2. Davis, K., Stremikis, K., Squires, D., & Schoen, K. (2014). Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally.
  3. Hale, I. (2015). Add to cart? Canadian Family Physician, 61(11), 937-9, 941-4.
  4. Medicine’s ethical responsibility for health care reform—the Top Five list. N Engl J Med. 2010;362(4):283-285.
  5. Choosing Wisely. History. Accessed October 12, 2015.
  6. Choosing Wisely Canada. What is CWC. Accessed Oct 12, 2015.
  7. Emergency medicine (2015). Retrieved April 2, 2016, from


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