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Invited Commentary
May 27, 2013

Swimming Upstream: Doing Less in Health Care Is HardComment on “No Papanicolaou Tests in Women Younger Than 21 Years or After Hysterectomy for Benign Disease” and “Cervical Cancer Screening Intervals, 2006 to 2009”

Author Affiliations

Author Affiliation: Department of Family & Community Medicine, University of Missouri, Columbia.

JAMA Intern Med. 2013;173(10):856-858. doi:10.1001/jamainternmed.2013.535

The Choosing Wisely initiative of the American Board of Internal Medicine Foundation has helped draw public attention to the need for physicians to take an active role in improving the value of American health care by doing less. A collaborative effort of many specialty societies, the Choosing Wisely initiative was a unique step forward in raising awareness of what must become an accepted topic for open and honest discussion; many tests and treatments are overused or used in clinical situations in which there is either no benefit or the possibility of benefit does not outweigh the risk of harm. Overuse of screening tests in the asymptomatic adult is an example of an area where progress could be made. But how hard is it to do fewer tests? In this issue, 2 articles address screening for cervical cancer.1,2

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