[2] The campaign is based on the notion that unnecessary tests, treatments, and procedures often do more harm than good, resulting in poor clinical outcomes and significant waste in the Canadian healthcare system.

Choosing Wisely Canada stems from worldwide concern around providing unnecessary treatment when the risk of harm exceeds its potential benefit ("medical overuse").

[11] Further studies highlighted the financial strain of medical overuse, such as the analysis conducted by the Institute of Medicine, which found that up to 30% of American health care spending is on unnecessary tests and procedures.

[12] In 2017, a joint report between Choosing Wisely Canada and the Canadian Institute for Health Information found up to 30% of tests and treatments were unnecessary based on eight campaign recommendations.

[13] In light of these concerns, Choosing Wisely Canada hopes to optimize value, reduce waste and improve patient outcomes by promoting patient-physician conversations about low-value care.

[14] Wendy Levinson, a Canadian physician and previous chair of the ABIM Board of Directors, was involved in launching the Choosing Wisely campaign in the United States.

[1] In the first wave of the campaign, nine national medical specialty societies released evidence-based lists of 41 tests, treatments and procedures that provided no benefit or potentially caused harm to patients.

[1] Under the leadership of Wendy Levinson and the Canadian Medical Association, Choosing Wisely Canada initially gained momentum in Ontario and subsequently became a national movement.

The campaign has partnered with more than 80 Canadian medical specialty societies to develop evidence-supported lists of "Things Clinicians and Patients Should Question", hoping to promote conversation about inappropriate care.

[17] CWC has also developed complementary patient-friendly education materials, and has begun to embed lessons focusing on resource stewardship in undergraduate and postgraduate medical curricula.

[17] In order to unify grassroots projects occurring across Canada to implement clinician recommendations, CWC additionally developed the Early Adopters Collaborative, which serves as a "learning platform for sharing knowledge, tools and experiences among participating organizations".

[20] National specialty societies are free to determine the process for generating their lists, as long as they are done in accordance with the following principles:[1] Choosing Wisely Canada recommendations are not intended to be used to establish payment and coverage decisions.

At the local level, hospitals, health regions and clinician groups across the country are working under their own initiative to find innovative ways to put the recommendations into practice.

Choosing Wisely Canada recommendations range from avoiding overuse of broad practices such as unnecessary and potentially harmful screening, diagnostic and radiographic services, to specific tests which are not supported by evidence to improve patient outcomes.

Since reducing unnecessary tests and procedures may result in lowering healthcare costs, the campaign may be viewed as a cost-cutting or rationing measure, which could in turn "undermine both physician engagement and patient trust.

[35] Additionally, Choosing Wisely Canada has developed patient-friendly materials with straightforward, lay language to explain common tests, with a "When you need them and when you don't" approach.

"[37] Chris Simpson, past president of the Canadian Medical Association, Professor of Medicine and Chief of Cardiology at Queen's University, Kingston, notes "Physicians are really embracing the principles behind Choosing Wisely.

[38] Rick Glazier, senior scientist in primary care and population health at the Institute for Clinical Evaluative Sciences in Toronto, highlights two aspects of the campaign that he believes are unique and have great potential.

[44] Others recognize the noble goal of reducing overuse and harm, but lament that the lists are too simplistic and do not necessarily advance the identification of low-value care, but merely synthesize "agreed-upon, well-established practices".

[46] In spite of these criticisms, Clement and Charlton "strongly believe in the global spirit behind the Choosing Wisely campaigns and movement" and "advocate that the priority in 2015 should be thoughtful implementation and rigorous evaluation of existing top five lists".

[46] Choosing Wisely Canada has identified a multifaceted evaluation approach to measure its impact, which includes:[34] Evaluation of campaign impact on patient education and receptiveness included a randomized control trial entitled EMPOWER (Eliminating Medications Through Patient Ownership of End Results), led by Cara Tannenbaum, geriatrician and professor in the Faculties of Medicine and Pharmacy at the Université de Montréal.

[47] The impact of Choosing Wisely Canada on test ordering and utilization was studied at the North York General Hospital in the Greater Toronto Area, one of the early adopters of the campaign.

[25] In addition to reducing inappropriate thyroid function testing, the impact of Choosing Wisely Canada is felt through numerous physician and patient awareness campaigns conducted at the hospital.