—Andrew E. Sama, MD, FACEP, ACEP Chair of the Board and Immediate Past President

I think it would be interesting to pose this question to the trial attorneys whether the Choosing Wisely recommendations constitute safe harbors. Let’s have somebody else debate this issue rather than us trying to make a statement that may appear to be self-serving. I wonder what the president of ATLA [the Association of Trial Lawyers of America] would say.

—Paul D. Kivela, MD, FACEP, ACEP Secretary-Treasurer

As per my reply to Dean, this is all about risk benefit continuum or spectrum—in other words, how much certainty for how many dollars cost for the patient and how much risk for doing or not doing the test or procedure, which entails health risk for the patient and medical liability and career risk for the physician.

Medical liability must be addressed. Agree with Sama, a letter to the editor that clarifies that issue would be appropriate.

—Alexander M. Rosenau, DO, FACEP, ACEP President

Let’s move forward and try something different. Let’s establish safe harbors and advertise that this will save waste from the system … Safe harbors to improve patient safety and decrease health care costs.

— ACEP Secretary-Treasurer Paul D. Kivela, MD, FACEP

My question is perhaps a philosophical one. It doesn’t seem to matter if it’s right or if it’s wrong but how it is perceived. So why do we continue to self-advocate as it rarely seems to be effective in changing public opinion? I think we need to go and try something different from time to time. It seems like we are writing too many letters to editors to clarify misperceptions.

I would rather have articles written in our favor the first time around. What about pitching this to the LA Times if not The Wall Street Journal and having them ask the trial attorneys how they feel about safe harbors for Choosing Wisely measures. For balance, they can ask the insurance companies and the regulators.

—Paul D. Kivela, MD, FACEP, ACEP Secretary-Treasurer

Think Paul has struck a nerve.

Recently, an ACEP leader gave a talk about “What I learned in Washington.” It was illuminating. He says no one cares what we think. If we say it, then it is automatically seen as being self-serving and not to be trusted. [Politicians] want recommendations and data from impartial sources.