Abstract
Objective: To assess perspectives of Pakistani emergency physicians regarding the American College of Emergency Physician’s Choosing Wisely Recommendations

Methodology: Physicians working in the emergency department of three hospitals in Pakistan were included in this cross-sectional study. The interviewer-administered study questionnaire was formulated as per ACEPs Choosing Wisely recommendations for emergency physicians. The study questionnaire was validated, and informed written consent was obtained from all the study participants. Ethical approval was taken from the ethical review board of Poonch Medical College, Azad Kashmir, Pakistan. Data was analyzed by SPSS v23.0 and was presented in tables and charts.

Results: Out of 70 emergency physicians, 63 responded and were included in the study (response rate = 90%). More than two-thirds of the physicians (68.3%) had never heard of Choosing Wisely recommendations and more than three-quarters (77.8%) had never discussed it with anybody. Eighteen physicians (28.6%) who knew about it had heard about it from their colleagues. Physician’s beliefs about Choosing Wisely campaign were as follows: 28.6% believed it will strongly increase patient safety, 39.7% believed it will somewhat increase the quality of patient care, and 57.1% believed it will have no impact on physician’s salary. The most important reason (38.1%) behind ordering a low-value investigation is due to fulfillment of patients request.

Conclusion: This study identified emergency physicians’ low level of familiarity with Choosing Wisely recommendations. With the ever-increasing national health cost, issues of drug resistance and hospital acquired infections, it is important to optimize the health care and expenditure. Educating physicians and patients with Choosing Wisely recommendations may decrease unnecessary investigations and procedures, over use of antibiotics and improve doctor-patient communication.

Key words: Choosing wisely, emergency physician, Pakistan