明智選擇 ? 醫療狂飆後的反思運動

近年來衛生福利部倡議明智選擇(Choosing Wisely)，各醫療院所亦開始思索如何投入此運動。明智選擇是為了壓制低效益醫療對病人安全的傷害及醫療成本的損耗，在2012年由美國內科醫學會基金會開始倡議的新觀念，之後國際間相繼響應成為一項全球性的運動。活動透過各學會提出其領域最常見的5到10項過度診斷或過度治療的項目，彙整後形成一個建議清單，讓醫療人員及民眾得知哪些處置為低效益醫療，以便揚棄或減少使用。要正確執行明智選擇可透過限制、減量、和溝通三種方法來達成。醫病共享決策(Shared Decision Making, SDM)很多時候是協助溝通來達成明智選擇的手段之一。本文除了闡述了明智選擇的內涵、源起及執行方式，也說明了它和SDM的差異，希望對讀者認識及實踐明智選擇有所幫助。  As the Ministry of Health and Welfare campaigns for the idea of “Choosing Wisely,” hospitals in Taiwan have been working to see how they could contribute to this campaign. An initiative proposed by the American Board of Internal Medicine (ABIM) Foundation in 2012, Choosing Wisely serves to reduce the harm of low-value care to patient safety and the cost due to such care. This initiative later became a global movement with the support it gained from countries worldwide. In an event held by ABIM, they asked the participating associations to list 5 to 10 most common types of overdiagnosis or overtreatment in their fields. Based on items they provided, a list was then compiled to inform health-care professionals and the public of the low-value care practices for them to decide whether to stop or reduce such practices. The implementation of Choosing Wisely can be achieved through the actions of “Limit, Lean, or Listen”. Shared decision making is one of strategies to achieve Choosing Wisely through “Listening”. This article discussed the meaning, history, and implementation of Choosing Wisely and how it differs from shared decision making, with the aim of improving readers’ understanding and practice of Choosing Wisely.