The Tension Between Pragmatism and Rigor in Choosing Wisely.

The Choosing Wisely campaign launched in 2012, aiming to “promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.”1 Since 2012, Choosing Wisely has grown into a powerful, globally recognized brand in medicine. The campaign’s process for creating top 5 lists of practices that “physicians and patients should question” is distributed and pragmatic: individual medical specialty societies identify members to create a list for their specialty, and members generate the list using methods that range from minimally structured (discussion among members2) to highly structured and rigorous (task force formation and systematic review3). This flexible approach has enabled rapid and widespread creation and dissemination of Choosing Wisely lists, with >700 active recommendations from 78 specialty societies.4,5 However, the variation in methodologies used for list generation across specialties has recently been criticized,6 and some experts have questioned the quality of the evidence supporting previous Choosing Wisely recommendations for adult and pediatric hospital medicine.7 The first pediatric hospital medicine (PHM)–focused list of Choosing Wisely recommendations was published in 2013, generated through a Delphi process convened by the Quality and Safety Committee of the Society of Hospital Medicine.8 In this issue, Tchou et al9 provide a timely and much-needed update to the 2013 Choosing Wisely list for PHM. To produce the 2021 list, the team took a more multidisciplinary and structured approach, compared with that of the 2013 list. Leaders of 3 national PHM professional groups (Society of Hospital Medicine Pediatrics Special Interest Group, the American Academy of Pediatrics (AAP) Section on Hospital Medicine, and the Academic Pediatric Association Hospital Medicine Special Interest Group) nominated members with expertise in high value care, research, and …