DRUG resistance

Cut prescriptions and choose treatments wisely!

Prescribing antibiotics for a viral infection with fever, a cold and a cough? There is no point! This is the best-known example of over-use in medicine. There are also numerous examples of diagnostic procedures and therapies that are pointless, yet still being doled out in surgeries and hospitals – sometimes even harming a patient. This is set to change, according to the German Society of Internal Medicine (DGIM), which has launched ‘Klug entscheiden’, modelled on the USA’s campaign ‘Choosing Wisely’.

Report: Bettina Döbereiner

Emeritus Professor Ulrich R Fölsch, General Secretary of the German Society of...
Emeritus Professor Ulrich R Fölsch, General Secretary of the German Society of Internal Medicine (DGIM).
Source: DGIM

That country is not alone. Worldwide, Canada’s campaign runs alongside the USA’s version, and the Swiss, Dutch and Italians have also adopted the concept. A Choosing Wisely campaign is also planned for by Great Britain, Australia, New Zealand and Japan.

The German campaign consists of 3-5-point checklists per specialist medical discipline, aimed at alerting doctors and patients to typical examples of over-use. The attraction of the campaign: ‘First, the doctors are encouraged to compile these checkpoints with patients and patients’ representatives. Second, the lists are meant to be written in such a way that patients can also understand them,’ explained Emeritus Professor Ulrich Fölsch, DGIM General Secretary and former Director of the Department of Internal Medicine I, at the Schleswig-Holstein University Medical Centre, when introducing the campaign in Berlin this February.

The model for the DGIM campaign was initiated as Choosing Wisely in 2012 by the American Board of Internal Medicine (ABIM), with which 60 specialist medical societies are currently involved. In line with the campaign’s US motto – Five things physicians and patients should question – The North American Spine Society, for example, begins its checklist with the statement: ‘Don’t recommend advanced imaging (i.e. MRI) of the spine within the first six weeks in patients with non-specific acute low back pain in the absence of red flags.’

Campaign is in its infancy

Red flags signify, among other things, the presence of trauma history, unintentional weight loss or immunosuppression. However, the above-mentioned example does not fall within the field of internal medicine represented by the DGIM. The German campaign is also still in its infancy. As recently as the beginning of 2015, Prof. Fölsch asked all eleven DGIM member societies representing, for example, cardiology, pulmonology and intensive care, to name three to five examples of over-use, but also under-use in their specific medical disciplines. This will be further discussed and consented in a conference prepared for early May this year.

The fact that so-called under-use will also be addressed is one of two differences between the German campaign and American trailblazer. The second, more important difference concerns scientific safeguarding. Feedback from the different medical societies is to be checked for scientific verifiability based on existing, evidence-based directives before publication.

The first German organisation to engage with the 'Choosing Wisely' theme, and discuss the relevance and methodical challenges in specific workshops, was the German Network Evidence Based Medicine (DNEbM). Daniel Strech, Member of the Board at the DNEbM, values the DGIM initiative as well as similar campaigns currently being initiated by other organisations. He appeals for the implementation of the campaign in a patient-oriented and science-based manner.

Professor David Klemperer, from the Regensburg University of Applied Sciences, and member of a working group within the Association of the Scientific Medical Societies in Germany (AWMF), which is focusing on the implementation of a Choosing Wisely campaign under the patronage of the AWMF, also hopes for good cooperation with the DGIM. Klemperer assumes that, in coming weeks, it will be possible to integrate the DGIM initiative into the efforts of the AWMF and to develop a joint campaign that all 168 specialist societies within the AWMF can join. ‘Such comprehensive implementation of the campaign would be very significant, also in comparison with the American and Canadian Choosing Wisely campaigns,’ says Klemperer, who is also a member of the 2014 established Choosing Wisely International Working Group.


Editor’s note: The effects of such a campaign on volumes of laboratory, pharmaceutical, imaging and usage of a multitude of other medical supplies is inestimable, at this stage. In addition, ethical questions must be addressed and debated regarding what is or is not really essential.


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