The CSEM Quality Improvement Committee was struck and charged by the CSEM Executive in late 2013 to work with Choosing Wisely Canada, a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures. They co-developed the first Five Things Physicians and Patients Should Question, which were released in October 2014:

• Don’t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.
• Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests unless there is a palpable abnormality of the thyroid gland.
• Don’t use Free T4 or T3 to screen for hypothyroidism or to monitor and adjust levothyroxine (T4) dose in patients with known primary hypothyroidism, unless the patient has suspected or known pituitary or hypothalamic disease.
• Don’t prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency.
• Don’t routinely test for Anti-Thyroid Peroxidase Antibodies (anti–TPO).

The Committee will continue to work with Choosing Wisely Canada to develop further evidence-based recommendations for clinical practice, with the goal of helping to achieve appropriate and sustainable improvements in health care.