The Romanian Society of Internal Medicine’s Choosing Wisely Campaign

Abstract

Quality of care in medicine is not necessarily proportional to quantity of care and excess is often useless or even more, potentially detrimental to our patients. Adhering to the European Federation of Internal Medicine’s initiative, the Romanian Society of Internal Medicine (SRMI) launched the Choosing Wisely in Internal Medicine Campaign, aiming to cut down diagnostic procedures or therapeutics overused in our country. A Working Group was formed and from 200 published recommendations from previous international campaigns, 36 were voted as most important. These were submitted for voting to the members of the SRMI and posted on a social media platform. After the two voting rounds, the top six recommendations were established. These were: 1. Stop medicines when no further benefit is achieved or the potential harms outweigh the potential benefits for the individual patient. 2. Don’t use antibiotics in patients with recent C. difficile without convincing evidence of need. 3. Don’t regularly prescribe bed rest and inactivity following injury and/or illness unless there is scientific evidence that harm will result from activity. Promote early mobilization. 4. Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date. 5. Don’t prescribe opioids for treatment of chronic or acute pain for sensitive jobs such as operating motor vehicles, forklifts, cranes or other heavy equipment. 6. Transfuse red cells for anemia only if the hemoglobin concentration is less than 7 g/dL or if the patient is hemodynamically unstable or has significant cardiovascular or respiratory comorbidity. Don’t transfuse more units of blood than absolutely necessary.

The challenge of implementing Less is More medicine: A European perspective

“…Several medical societies across the world launched quality driven anti-waste campaigns such as Choosing Wisely in US [7,8], Smartermedicine in Switzerland [9], Slow Medicine in Italy [10], SMART Medicine Initiative in Israel, and Choosing Wisely in UK, France, Belgium, Portugal, Romania, Russian Federation and Poland. These societies published "top-five lists" of low-value medical interventions which should be avoided [ [11][12][13][14][15][16]- [17]]. These lists should be used to help make wise decisions in each clinical domain, by engaging patients in discussions about unnecessary tests, treatments and procedures.…”