Balancing cost and care in physiotherapy

Rethinking Physiotherapy: Are We Overtreating Patients?

Avery Sinclair in Health & Wellness June 2025 • 4 min read.

"A critical look at the 'Choose Wisely' campaign and its implications for UK physiotherapy practices in an era of increasing healthcare costs."

In an era where healthcare budgets are increasingly stretched, the 'Choose Wisely' campaign has emerged as a significant movement, urging healthcare professionals to carefully evaluate the clinical and cost-effectiveness of their interventions. Originating in the United States, this initiative has since spread to numerous countries, including Canada, Australia, Japan, Germany, and France, sparking crucial conversations about the value of medical treatments.

This article delves into the 'Choose Wisely' campaign, examining the core concepts that drive its mission. We'll explore the ethical dimensions of this campaign within the UK's healthcare landscape, aiming to stimulate a vital discussion: Should UK-based physiotherapists embrace the 'Choose Wisely' approach?

The 'Choose Wisely' campaign can be traced back to 2009, when the National Physicians Alliance in the US supported volunteers across primary care specialties to identify commonly used interventions and tests that offered little to no benefit to patients. In 2012, the 'Choose Wisely' campaign was officially launched, leading professional organizations worldwide to develop lists of treatments that may not provide significant medical value or have similar outcomes to less expensive alternatives. 'Low-value care' has become the common term for these procedures.

Understanding the Core Concerns: Medicalization, Overdiagnosis, and Consumerism

Balancing cost and care in physiotherapy

The 'Choose Wisely' campaign is rooted in three primary concerns: medicalization, overdiagnosis, and medical consumerism. These issues have gained prominence through numerous publications over the past decade, prompting healthcare professionals to reconsider their practices.

Medicalization refers to the process by which non-medical aspects of life become defined and treated as medical problems. Sociologists have long observed how medicine shapes society's understanding of health and illness. Conditions once considered normal parts of life are now viewed as medical issues, influenced not only by healthcare professionals but also by biotechnology industries, insurance companies, and consumer groups.

Medicalization: The process by which non-medical problems become defined and treated as medical issues.
Overdiagnosis: Diagnosing a biomedical condition that, without testing, would not cause symptoms or death.
Medical Consumerism: The over consumption of healthcare, driven by pharmaceutical companies and society's focus on health as a form of social capital.

Overdiagnosis, another key concern, involves diagnosing biomedical conditions that would not cause symptoms or death without testing. This includes tests and interventions that add little to a patient's overall management. Factors such as technological advancements, financial incentives, and fear of litigation contribute to overdiagnosis in contemporary healthcare.

The Path Forward: Choosing Wisely in the UK

The 'Choose Wisely' campaign presents both opportunities and challenges for UK-based physiotherapists. While governance mechanisms like NICE already offer guidance on effective interventions, 'Choose Wisely' provides a focused approach to identifying and reducing low-value care. Ultimately, the decision to embrace this campaign requires careful consideration of ethical implications, potential political issues, and the unique context of the UK healthcare system. By engaging in open dialogue and critical self-reflection, physiotherapists can ensure they are providing the most valuable and effective care to their patients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.physio.2018.07.001, Alternate LINK

Title: Should Uk Based Physiotherapists Choose Wisely?

Subject: Physical Therapy, Sports Therapy and Rehabilitation

Journal: Physiotherapy

Publisher: Elsevier BV

Authors: Graham Copnell

Published: 2018-12-01

Everything You Need To Know

What is the 'Choose Wisely' campaign, and what is its main goal?

The 'Choose Wisely' campaign is a movement that encourages healthcare professionals, including physiotherapists, to evaluate the clinical and cost-effectiveness of their interventions. It challenges practitioners to reconsider common treatments and tests, advocating for those that offer the most value to patients. The campaign, originating in the United States, has spread internationally, prompting discussions about low-value care and the ethical considerations of healthcare practices.

What are the core concerns that drive the 'Choose Wisely' campaign?

The 'Choose Wisely' campaign addresses three core concerns: 'Medicalization', 'Overdiagnosis', and 'Medical Consumerism'. 'Medicalization' involves treating non-medical issues as medical problems, often influenced by various stakeholders. 'Overdiagnosis' involves diagnosing conditions that might not cause harm without testing. 'Medical Consumerism' refers to excessive healthcare consumption, influenced by pharmaceutical companies and societal views on health. These concerns drive the campaign's mission to reduce unnecessary interventions and promote more efficient healthcare practices.

How does 'Medicalization' impact physiotherapy?

Medicalization is the process where non-medical issues are treated as medical problems. This impacts physiotherapy because it can lead to the treatment of normal life experiences as if they were medical conditions, potentially leading to unnecessary interventions. Societal and industry influences, as highlighted in the context, shape our understanding of health, and medicalization can skew this understanding, impacting physiotherapy practices by influencing which conditions are treated and how.

What is 'Overdiagnosis', and how does it relate to physiotherapy practices?

Overdiagnosis involves diagnosing conditions that may not cause symptoms or death. In physiotherapy, this could mean identifying issues through tests or interventions that do not significantly improve patient outcomes. Factors such as technological advancements, financial incentives, and fear of litigation contribute to overdiagnosis, potentially leading to patients undergoing treatments that offer little benefit, and 'Choose Wisely' attempts to address this issue by promoting the careful evaluation of tests and interventions.

What are the implications of the 'Choose Wisely' campaign for UK-based physiotherapists?

The 'Choose Wisely' campaign presents both opportunities and challenges for UK-based physiotherapists. It allows physiotherapists to identify and reduce 'low-value care', offering an opportunity to provide more valuable and effective care, aligning with existing governance like NICE. However, embracing 'Choose Wisely' requires careful consideration of ethical implications and the unique context of the UK healthcare system, encouraging open dialogue and critical self-reflection to ensure optimal patient care.