Choosing wisely

‘Choosing Wisely’ started in the USA in 2011 but it only came into Hyperion's all-seeing gaze in 2015. The idea is to promote ‘care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary’, so it is a bit like an informal version of NICE guidance. Each specialty or discipline is encouraged to choose their ‘top 5'. A top 5, or perhaps a ‘bottom 5’ of ‘don't do it' for neonatology was recently achieved by a Delphi methodology supplemented by evidence review (Pediatrics 2015;136:e482–9). The resulting list featured routine anti-reflux treatment for apnoea and desaturation, routine antibiotics beyond 48 hours for asymptomatic newborns, routine pre-discharge pneumograms, routine daily chest X-rays for intubated infants, and routine brain MRI at around 40 weeks or discharge home for preterm babies. I think most European neonatologists would look at this list and think ‘why would you?' But there must be things that are done on the Old World side of the Atlantic that could do with a bit of slash and burn thinking. If you would …