["Smarter Medicine" in ambulatory general internal medicine, at present and in future]

"Smarter Medicine" in ambulatory general internal medicine, at present and in future Abstract. Overuse and inappropriate care resulting in potential harm and unwarranted waste of healthcare resources were leading to the international "Choosing Wisely" campaign (CWC) almost a decade ago. In Switzerland, the movement started 2014 / 15 under the label "Smarter Medicine", with a top-5 list of interventions better to avoid in ambulatory general internal medicine (GIM). Yet from the beginning of the international CWC campaign, its effectiveness has been questioned, and we don't know if the "Smarter Medicine" top-5 list for ambulatory GIM efficiently is reducing overuse and inappropriate care, as there is almost no evaluation data available. The prerequisites for an efficient reduction of overuse and inappropriate care are a. the scientific evidence for the recommendations, b. the recommendations coming from a trusted source, c. reliable data for the evaluation, d. the active role of patients, the public, professional healthcare societies and politicians. Another key factor for a successful implementation is the involvement of the final users at an early stage of recommendation development. Keeping this in mind, we recently developed new suggestions for interventions better to avoid, in collaboration with 538 general practitioners. These suggestions lead to a next top-5 list for the ambulatory GIM.