Posted by: Duke Raleigh Hospital | May 6, 2014

Choosing Wisely; patients & physicians making smart decisions…together

Choosing Wisely website helps patients and physicians make a smart decision – together

By Carol Hahn, MD

Do I need cancer screening tests? Are Pap tests needed at every annual physical? If I have cancer, do I need to have treatment? What are my options and how long should it take? What about treatment for slow-growing prostate cancer … is it OK to watch and wait?

There is confusion – and there are sometimes contradictions – particularly in what one can find on

Dr. Carol Hahn

Carol Hahn, MD

the internet – when it comes to information about medical tests and treatments. Patients who wish to be active participants in their own health care – and I encourage all my patients to be – should spend time discussing suggested tests and treatments with their providers who have the most information about their health matters. But certainly there is much valuable information available online, and how can a consumer decide what is right to do when faced with contradictory information?

Fortunately for patients and doctors, there’s a new website with authoritative information from more than 50 different specialties. was begun as an initiative of the American Board of Internal Medicine (ABIM) Foundation to help patients and their doctors (and other health care stakeholders) start a conversation about which medical tests and procedures make good sense and which are unnecessary – and maybe even harmful.

Duke Raleigh is one of the hospitals leading the way in evidence-based medical care. There can be a fair amount of variance in health care, but when your quality of care is dictated by evidence, it means you’re getting the best care available. That was the thought behind the Choosing Wisely effort: Base treatment recommendations on scientific evidence.

For many years, more treatment or testing was considered the standard. But we now know that more isn’t always more. More can, frankly, be not helpful, costly and sometimes harmful.

So experts at the national level have come together to participate in the Choosing Wisely initiative and give the definitive word, based on evidence reviewed by experts, on recommendations for best care across a number of medical disciplines.

As a leader with the American Society for Radiation Oncology (ASTRO) and Chair of ASTRO’s Quality Council, I have been deeply involved in developing treatment guidelines for physicians in my specialty. I have also worked to develop my society’s items for Choosing Wisely. Our list of five items was put together to help patients choose care that is truly necessary, supported by evidence and free from harm.

An example of an area we clarified: radiation for patients with breast cancer – how many treatments do I need? For women with early stage breast cancer, radiation is an important portion of breast conserving therapy. This is the local treatment used for breast cancer that is as effective as mastectomy, but allows a woman to keep her breast. While older studies of breast radiotherapy generally used treatment courses of five to six weeks, more recent data has demonstrated that in many patients, three to four weeks of treatment are just as safe and effective. Women with early breast cancer should discuss this with their physicians to see if shorter treatment is right for them.

The Choosing Wisely effort is national in scope and is aimed at everyone with a stake in health – from patients and their families to health care providers to health insurance companies. The website has some resources aimed at physicians, but there are patient-friendly resources, as well.

Patients should always have all treatment options discussed with them. Knowing all the tests and treatments available is the only way to make an informed decision about your health. It’s what I’ve always tried to do in my practice. Now – thanks to this website and effort – doctors and patients across the country can begin (or continue) to have these informed discussions.

When it comes to your health, get the facts, have a candid discussion with your doctor and – together – choose your course of action wisely.

Carol Hahn, MD is a radiation oncologist at Duke Radiation Oncology. Learn more about guidelines on medical tests and treatments at

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