Art of Medicine
Sep 2020

Choosing Unwisely

Abey Kozhimannil Thomas, MD
AMA J Ethics. 2020;22(9):E816-817. doi: 10.1001/amajethics.2020.816.


This comic visually conveys the absurdity of overreliance on symptom measures and excessive testing in contemporary clinical decision making and health care practice.


Figure. Choosing Unwisely



Sketched with pencil on paper; finished in Corel Paintshop.



Diagnostic tests or procedures are unnecessary and potentially sources of iatrogenic harm when ordered out of fear of litigation or for some other reason that does not motivate or inform good care of a patient.1 Organizations and health care professional societies have introduced many initiatives, among which Choosing Wisely is one of the most widely known,2 to emphasize the importance of evidence-based, patient-centered approaches to diagnostic decision making.3


  1. Morgan DJ, Leppin AL, Smith CD, Korenstein D. A practical framework for understanding and reducing medical overuse: conceptualizing overuse through the patient-clinician interaction. J Hosp Med. 2017;12(5):346-351.
  2. 2020;

    Choosing Wisely® website. Accessed June 8, 2020.

  3. American College of Radiology. ACR Appropriateness Criteria. Accessed July 23, 2020.


AMA J Ethics. 2020;22(9):E816-817.



Conflict of Interest Disclosure

The author(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.