The Choosing Wisely Campaign: What Behavioural Science Adds 

Clinicians still order tests, treatments and procedures that add little value for patients – even when clear guidance says not to. The Choosing Wisely campaign tackled this with specific recommendations, and behavioural science explains why a list alone is rarely enough: much clinical decision-making is intuitive, habitual and open to cognitive bias. 

Key takeaways 

• Choosing Wisely grew from nine to more than 80 US specialty societies and published over 700 recommendations. 

• Commission bias, impact bias and sunken-cost bias all push clinicians towards low-value care. 

• Framing, messengers, defaults and peer feedback turn a recommendation into action. 

What Is the Choosing Wisely Campaign? 

The Choosing Wisely campaign was launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation with Consumer Reports, to cultivate conversations between clinicians and patients about avoiding unnecessary tests, treatments and procedures¹. 

Starting with nine specialty societies, it grew to more than 80 by the time the US campaign wound down in 2023, having published over 700 recommendations and inspiring more than two dozen similar campaigns in other countries. The recommendations are refreshingly specific – such as “don’t order annual ECGs for low-risk patients with no symptoms”. 

Why Isn’t a List of Recommendations Enough? 

Because a list of recommendations, on its own, doesn’t address the cognitive biases shaping clinician behaviour. As Professor Ian Scott and colleagues in Brisbane put it, much everyday clinical decision-making is intuitive rather than analytical – guided by habits and heuristics – which makes it systematically vulnerable to bias⁴. We saw the same pattern in how behavioural science helps reduce doctors’ over-testing.

Which Cognitive Biases Drive Low-Value Care? 

Scott and colleagues identify three: commission bias, impact bias and sunken-cost bias⁴. 

• Commission bias: the desire to avoid the regret of not having acted, even when watchful waiting might be better – part of why some clinicians order exhaustive end-of-life interventions. 

• Impact bias: overestimating the benefits of an intervention relative to its harms, which can leave patients worse off financially, physically and emotionally. 

• Sunken-cost bias: continuing down a path because of the time, money or effort already invested, rather than because it’s still right for the patient. 

How Has Choosing Wisely Been Applied in Asia-Pacific? 

Australia has built its own version of the campaign, and Japan has followed more recently. 

• Choosing Wisely Australia: facilitated by NPS MedicineWise since 2015, with 45 member organisations contributing more than 190 recommendations – including a set for GPs³. 

• Japanese emergency medicine: emergency physicians published nine consensus recommendations to reduce low-value tests and treatments². 

• Lesson for practice: recommendations from trusted professional bodies and peers in the same specialty are easier to accept. 

Working on a low-value care programme? DeltaMV’s Healthcare Behavioural Strategy team can help you design recommendations around how clinicians actually decide. 

How Can Behavioural Science Make Choosing Wisely Work? 4 Steps 

1. Reframe the recommendation – make watchful waiting feel like an active choice rather than inaction. 

2. Choose the right messenger – peers and professional bodies carry weight. 

3. Change the default at the point of care – see nudges and choice architecture. 

4. Give feedback and build bias awareness – as in reducing GP over-prescription of antibiotics. 

What Are the Limitations of Recommendation Lists? 

• A list alone rarely changes habits: recommendations compete with years of habit and professional identity. 

• Campaigns need ongoing ownership: the US campaign wound down in 2023, although its recommendations remain archived. 

• Bias is not a criticism of clinicians: interventions should support clinicians, not blame them. 

Frequently Asked Questions 

How does behavioural science relate to Choosing Wisely? 

It explains why recommendations alone don’t always work: everyday clinical decisions are often intuitive and vulnerable to biases such as commission, impact and sunken-cost bias. 

Is there a Choosing Wisely campaign in Asia-Pacific? 

Yes. Choosing Wisely Australia has 45 member organisations, and Japanese emergency physicians have published nine recommendations. 

What is commission bias in medicine? 

A clinician’s desire to avoid the regret of not having acted, even when watchful waiting might be better. 

Next Steps: Turn Bias Awareness Into Behaviour Change 

Clinical decision-making is not as rational or evidence-driven in the moment as most of us assume – so a recommendation list alone is rarely enough. DeltaMV’s Healthcare Behavioural Strategy practice translates research like Scott and colleagues’ into the nudges, messaging and tools that close the gap between guideline and consultation room. 

Want help turning a Choosing Wisely-style recommendation into real behaviour change? Get in touch with DeltaMV’s Healthcare Behavioural Strategy team. 

References 

1. Cassel, C. K., & Guest, J. A. (2012). Choosing wisely: Helping physicians and patients make smart decisions about their care. JAMA, 307(17), 1801–1802. https://doi.org/10.1001/jama.2012.476 

2. Hanaki, N., Miyata, J., Yamada, Y., & Shiga, T. (2023). Choosing Wisely® in Japanese emergency medicine: Nine recommendations to improve the value of health care. The Journal of Emergency Medicine, 64(3), 371–379. https://doi.org/10.1016/j.jemermed.2023.01.005 

3. NPS MedicineWise. (n.d.). Choosing Wisely Australia. Retrieved October 19, 2026, from https://www.nps.org.au/choosing-wisely 

4. Scott, I. A., Soon, J., Elshaug, A. G., & Lindner, R. (2017). Countering cognitive biases in minimising low value care. Medical Journal of Australia, 206(9), 407–411. https://doi.org/10.5694/mja16.00999