there was delighted to hear steve weinberger from that acp came to talk about choosing wisely with the extraordinarily important initiative where the specialty societies are identified the top five things that we should be doing less up and i am delighted to hear the doctor is going to put choosing wisely into the curriculum here at st. peter's. what is the next up? we have to go for the bigger ticket items the overuse of a heart bypass, hysterectomy , like changing events and we know from what physicians have said in a report under the auspices that these big ticket procedures are overused. it is interesting to note that overuse was taken off as the explicit priority of a national group called the national quality forum. that happened not long ago and it is interesting like it happened and it is unclear but with those forces that no one to overuse on the national agenda in will be up to the public to put it back on the agenda. to have the pleasure of working with progressive and thoughtful people in other procession lahn negative professions i will share this e-mail that i receive fro