LAUSR

In Reply We thank Fralick and colleagues and Novack and colleagues for their thoughtful response to our Invited Commentary.1 The Choosing Wisely campaign is an important movement in medicine in the United States, and we applaud the authors of the Choosing Wisely campaign for its success. The campaign’s effects clearly extend beyond mere conversation to promote value as a central tenet of the medical profession. Respectfully, however, we suggest that having established a strong foundation, we must expand Choosing Wisely to address the complex and persistent problem of low-value care. With regard to the Choosing Wisely video modules, we support the goal of tying them to maintenance of certification and continuing medical education. Our comments were meant to highlight further opportunities for development. This includes more closely linking recommendations to practical decision-making tools. More pressing, we should use Choosing Wisely’s popularity to promote greater emphasis on communication skills in the training and certification of physicians at all levels. Whether it is termed shared decisionmaking or otherwise, this includes an ability to explain the best evidence on risks and benefits with facility, as well as to elicit patient goals with empathy. There remain many unanswered questions on how to achieve this goal most effectively. We hope that together, using Choosing Wisely as a platform, we can spur further investigation into how these essential skills can be imparted to ensure the best care for patients.