Why smarter medicine?

Frequently asked questions about the smarter medicine initiative

What is the purpose of "smarter medicine"?


Today, a great deal is possible in medicine. But not everything that is possible is actually useful in a specific case. According to the motto "Less is sometimes more", the non-profit association smarter medicine wants to draw attention to the issue of overuse and misuse in medicine. In order to raise awareness for good quality of treatment, a strong network of doctors, other health care professionals, patients and clients as well as decision-makers is needed to engage in a genuine dialogue. The association smarter medicine - Choosing Wisely Switzerland wants to contribute to this.

Why do we need a supporting association?


With the founding of the smarter medicine - Choosing Wisely Switzerland association in 2017, a strong network of doctors, other health professionals, patients and consumers was created. Together, we bring the issue of medical overuse and misuse into public focus from different perspectives.

What are the goals of the association?

  • Publication of further top five lists with unnecessary treatments from as many medical specialities and health professions as possible. For these lists to be credible, they must meet high quality criteria. It is therefore indispensable that such lists are compiled by the medical societies with professional responsibility.
  • Empowering patients to decide, together with the attending physician, which examinations and treatments are really indicated in their specific case.
  • To promote research in the area of overuse and misuse of health care in Switzerland.
  • In addition, the non-profit association wants to stimulate a public discussion about medical overuse and misuse.
  • Active inclusion of other health care professions (interprofessional approach).
  • Anchoring the topic of treatment quality as part of the education, further education and training of health professionals.

What are the recommendations of the (top five) lists based on?

The lists are based on the recommendations for sustainable, efficient and evidence-based medicine and are based on national and international studies. In the coming months, the lists of other professional societies will be published.


See also Top 5 lists

Why are only recommendations formulated and no guidelines issued?


smarter medicine does not want to and cannot issue new regulations, but can provide guidance in medical grey areas. Only in this way is it possible to address the individual situation of each patient. It is not possible to treat patients exclusively according to guidelines without addressing their individual needs.


See also article by Regula Capaul in special issue 'Primary and Hospital Care'.


Experiences from the NICE campaign in the UK have also shown that restrictive pressure leads to refusal. Instead, a broad network of all actors is needed to credibly communicate the core message that "less is sometimes more". Patients must never get the feeling that something is being withheld from them; they must always be convinced that the best possible treatment is available to them at all times.

Are these recommendations implemented at all?


The impact of medical recommendations is inherently difficult to measure, as there are no databases in Switzerland that measure changes in prescribing practices. A preliminary study from 2016 by the Policlinique Lausanne with the support of the SGAIM shows that almost 60% of the doctors surveyed are aware of the smarter medicine campaign; in the German-speaking part of Switzerland, the level of awareness is as high as 70%. Agreement with the recommendations of the SGAIM lists was 8.5 and 9 out of 10. The proportion of doctors who, according to their own statements, rarely deviated from the 4 recommendations in practice (not prescribing antibiotics for upper respiratory tract infections, refraining from systematic preoperative chest X-rays, avoiding diagnostic imaging of the lumbar spine in patients with acute lumbalgia without alarm signs or refraining from measuring prostate-specific antigen) was between 67 and 74%. In contrast, the recommendation for proton pump blockers (long-term pharmacotherapy for gastrointestinal symptoms without reduction to the lowest dose) is only followed by 33% of the doctors surveyed.

Is it known why doctors do not comply with the recommendations?

As the survey of the Policlinique Lausanne shows, the patients' wishes and the assumption that other doctors would prescribe the therapy they wanted anyway are the decisive factors. In the USA, the fear of being sued for malpractice is listed as an additional reason.

These findings show the importance of patient awareness and the problem of misuse and overuse in the implementation of the smarter medicine campaign. In addition, it seems indispensable that GPs with their experience background are also involved from the beginning in the development of further recommendations. There is a need for further public discourse on the value of medical interventions so that the recommendations are better implemented.


See also the article by Stefan Neuner-Jehle in the special issue 'Primary and Hospital Care'.

Why do the other professional organisations in the health care sector also participate in the smarter medicine - Choosing Wisely Switzerland association?

They are doing so out of the deep conviction that only with good interdisciplinary cooperation can patients be offered the best possible treatment. In addition, certain recommendations of the medical societies affect other health care professions very directly. A concrete example: In an SGAIM list, it is recommended not to leave elderly people in bed for too long during a hospital stay. Such a recommendation directly interferes with the work of nursing staff and physiotherapists. It is therefore necessary to consider together with the professional groups involved how corresponding recommendations can be put into practice. This requires early treatment planning and the embedding of all measures in an interprofessional treatment chain.


See also the article by André Burki in the speciel issue ‚Primary and Hospital Care‘

Is smarter medicine primarily intended to reduce health care costs?


The organisations involved in the smarter medicine - Choosing Wisely Switzerland association are clearly in favour of the campaign being exclusively for the benefit of patients and not being hijacked by health economics. The primary aim is to find the best treatment for the individual patient according to the motto "the optimal not the maximum medicine". Doctors and patients should ask themselves together whether the treatment really brings a concrete benefit, bears risks or, in the worst case, can even cause harm. If this approach can reduce costs, all the better. If, on the other hand, permanent catheters are no longer inserted in the case of incontinence, for example, this saves care materials and thus money on the one hand, but on the other hand it is likely to increase the need for nursing staff.

Doesn't smarter medicine run the risk of rationing medical services?


With smarter medicine, patients are not deprived of sensible treatments, and it is in no way intended to save money at the expense of patients. However, patients cannot be interested in treatments that do not benefit them or even harm them. The freedom of choice of patients is not restricted by smarter medicine, but on the contrary expanded. Patients should make their decisions in dialogue with doctors, in which the question of the treatment that makes sense in a specific case is at the centre. If health care costs can be saved by dispensing with unnecessary examinations and treatments that can harm patients, this can be an effective means against rationing in other areas. Smart medicine is not about rationing, but about making wise decisions for the benefit of patients and ultimately to ensure high-quality medicine.


See also interview with Christoph A. Meier and Erika Ziltener in special issue 'Primary and Hospital Care'.