The study by Rosenberg et al1 illustrates how difficult it may be to achieve substantial reductions in unnecessary testing despite extensive awareness and publication of recommendations from the Choosing Wisely campaign. It may be that, rather than education, physicians need implementation tools built into the system of ordering laboratory or radiologic tests. Examples of this can be a priori criteria introduced onto the laboratory requisition form for a given test (ie, minimal criteria must be met for the test to be ordered), frequency-based restrictions (eg, a test cannot be ordered more often than every 3 months, with the timing of the most recent test monitored by the laboratory), or simply placing the test on a separate ordering form so that it is not captured in a carte blanche approach to test ordering.
Ferrari R, Prosser C. Testing Vitamin D Levels and Choosing Wisely. JAMA Intern Med. 2016;176(7):1019-1020. doi:10.1001/jamainternmed.2016.1929