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February 13, 2013

Decreasing the Frequency of Ordering Tests or Treatments—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Medicine, University of Toronto, Toronto, Ontario, Canada (

JAMA. 2013;309(6):546-547. doi:10.1001/jama.2012.113527

In Reply: We agree with Dr Walsh that rewarding students with higher grades in addition to celebrating their efforts as a method to encourage appropriate restraint could be very helpful.

We might take this 1 step further and suggest that all examination scenario questions that ask the student what he or she would order next should include the choice “nothing” or “wait and see what happens.”

By putting this choice everywhere, including on certification examinations, it would be clear that restraint is always an option.

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