Are Choosing Wisely Recommendations PDF Evidence-Based?

My mom ran a clinic her whole life, charging just five dollars for cold medicine. After I took over the clinic, I followed her teachings closely, doing my best to care for the folks in our community. However, after I charged an influencer 30 dollars for medication, I got blasted online as a scam clinic that was out to rob people blind. The entire town showed up at my door, young and old alike, demanding I return the 'overcharged' fees. I gave them exactly what they wanted and refunded every penny before shutting down the clinic for good. "There you go, just like you wanted. The clinic's closed. From now on, if you've got health concerns, feel free to drive 30 miles to the county hospital for consultation. I wish you all good health." The very next day, they were back at my door again. Only this time, they were begging me to reopen.

The new intern in our department, Astrid Stokes, had a soft, harmless look people viewed as innocent. She also claimed she could see a countdown over people's heads, ticking down to their deaths. Most of us just laughed it off and told her she had been reading way too many web novels. When an elderly man was rushed into the ER, she told the department head, Melanie Brooks, not to bother. She said the man wouldn't make it through the day. Melanie ignored her and pushed ahead with everything we had. The old man still died. The attending doctor even got slashed by the patient's family during the fallout. After that, people started to waver. During a team outing, Astrid suddenly screamed and told us not to get on a specific bus. She said if we did, we would all die. With no other choice, we switched vehicles. By the time we reached our destination, news came in. The bus we were supposed to take had lost its brakes and gone off a bridge. After that, almost everyone believed her. Everyone except me. The next day, she pointed straight at me. "Ruth shouldn't be a doctor anymore. If she stays, she'll get caught up in a medical dispute, and the whole department will end up dead or injured." Just like that, Melanie reassigned me. I went from doctor to janitor, handling medical waste. One day, I got scratched by a contaminated needle. Yet, no one would treat me. "Astrid already said it. This is her destiny. Anyone who gets involved will die, too." My body rotted from infection, sores breaking open across my skin. I died alone on the street, full of fury. When I opened my eyes again, I was back to the day Astrid first claimed she could see those death countdowns.

During the holiday, my husband and I attended a free health screening organized by our local community clinic. The doctors diagnosed me with late-stage lung cancer. But after a follow-up examination, I learned the truth—the hospital had mixed up the test samples. The one who actually had lung cancer was my husband. We had always had a loving marriage, so I rushed home in tears. On the way back, I had already made up my mind to use every cent of my savings to pay for his treatment. But the moment I reached the door, I heard our son's worried voice from inside. "Dad, it's already late-stage cancer. Treatment is just going to be a money pit." I was about to push the door open and tell them not to worry about the money when I heard my husband reply indifferently, "It's fine. Your mom's already terminal. Treatment would be a waste anyway. I'll convince her to give up." I froze on the spot. Without a word, I slipped the bank card containing 300 thousand dollars back into my pocket. Fine. Wonderful. Then give up treatment.

I was the sole heir to the Thirteen Needles of Revival, a legendary healing art. My consultation fee was twenty thousand dollars per visit, yet every year countless tycoons, politicians, and powerful elites lined up outside my door. As long as a patient still drew breath, the Thirteen Needles of Revival could pull them back from Death's doorstep. Over the past five years, I had awakened a wealthy businessman who had been declared brain-dead after a car accident. I had also prolonged the life of a centenarian suffering from multiple organ failure. Even terminally ill patients whose families had already been told to prepare for the worst were able to walk out of the hospital on their own after receiving my treatment. There was only one ironclad rule. I treated no more than ten patients a year. Once those ten slots were filled, no amount of money, power, or influence could change my mind. Whoever came next would have to wait until the following year. This year, only one slot remained. Suddenly, a group of bodyguards dressed in black burst through the door. They carried in a man covered in blood and dropped to their knees before me. “Please save our boss! We'll pay whatever it takes!” I looked at the man they carried inside and spoke coldly. “Take him out. I wouldn't save this man even if it killed me.”

The mother of Mr. Burr, the hospital director, was critically ill and needed emergency surgery. My wife, wanting to help her beloved crush, Cedric Grey, take the spotlight, deliberately kept the surgery time from me. By the time I finally arrived—late, Mr. Burr stopped me from entering the operating room and scolded me harshly for being unprofessional and unethical. Once I realized what my wife was doing, I handed the lead surgeon position over to her beloved crush. “Well, since you're so eager to shine,” I said coldly, “you’d better not screw it up.” The nurses tried to talk me out of it. They said I was being impulsive, that this was a rare chance to prove myself. However, none of them knew that I was the only doctor in the entire country capable of performing this rare and complex heart valve surgery. Even if Cedric managed to buy time with some miracle drug and made it look like the patient was improving, without my diagnosis and surgical skills, the operation was doomed to fail. And when that happens, he’d be held responsible. As for my wife, her blind favoritism would come back to haunt her.

My daughter, Bessie Garcia, had very little self-discipline. The only reason she studied at all was that I constantly pushed her. Three months before the SATs, I could not resist sending a question to myself ten years into the future. “Did Bessie get into an Ivy League school? What kind of job does she have now? Please tell me the last three years of hard work were worth it! How far have Meera and I gotten on our trip around the world? Did we have a second child?” A hopeful smile spread across my face. Then, I saw the man on the other side of the screen. His skin was sallow. He was so thin that he was almost unrecognizable. “An Ivy League school? After graduation, she publicly accused you of controlling and emotionally abusing her for more than ten years. The entire internet branded you a sick, controlling father. Meera divorced you and went on to have a child with her first love. As for you… years of staying up late, putting your life on hold, and constantly supervising Bessie’s studies left you with terminal pancreatic cancer. Your daughter and ex-wife have cut you out of their lives completely. You have only one month left to live.” I was stunned. Just then, Bessie’s voice sounded from her room as she talked to someone online. “My dad? He’s a pathetic control freak. His wife doesn’t love him, so he takes it out on me by trying to control my life. The more he forces me to study, the worse I’ll bomb the exams! Watching him lose his mind in rage is the only satisfaction I get. Once the SATs are over, I’m moving out and cutting him out of my life for good!” Tears splashed against the back of my hand. A moment later, I withdrew her from every SATs prep course and sent her a text. [You don’t have to attend those tutoring classes anymore. From now on, I won’t ask anything of you. It’s your life, so you should get to decide how to live it.]