Patients who go to the emergency room with a headache may not automatically get a CT scan.

Children with pink eye may be told to wait a couple of days and let it resolve on its own rather than use antibiotic eye drops.

Adults at low risk of heart disease may no longer be subjected to electrocardiograms at routine physicals.

When it comes to medical treatment and tests, less can be better, according to Choosing Wisely, a national campaign started by the American Board of Internal Medicine Foundation that is taking hold in Hawaii.

"I think there is a general feeling that more is better," said Dr. Melinda Ashton, chief quality officer for Hawaii Pacific Health, the state’s largest health care provider. "It’s absolutely clear that in medicine that certainly is not always true."

After carefully reviewing the latest evidence, more than 60 medical specialty societies have each come up with a list of five "Things Providers and Patients Should Question." The physician-driven initiative is aimed at breaking old, outdated habits that don’t improve health and at reducing inappropriate or even harmful care.

To ensure patients are full partners in the effort, Consumer Reports has developed easy-to-understand Choosing Wisely materials that are available free online to educate patients and their families and help them talk with their doctors about what is right for them.

Choosing Wisely was officially launched in 2012 with recommendations from the American Board of Internal Medicine and eight other specialty societies, such as family physicians and pediatricians. But new lists kept coming out as various specialties joined the campaign, including the American Academy of Sleep Medicine this month.

The advice is starting to be incorporated in hospitals and doctors’ offices in the islands.

Hawaii Pacific Health, for example, will soon be giving some of its doctors gentle nudges via their patients’ electronic records, asking them to think about whether Choosing Wisely guidelines apply in individual cases.

The initiative will be rolled out gradually, a few recommendations at a time, according to Ashton. Hawaii Pacific Health includes Kapiolani, Pali Momi, Straub and Wilcox hospitals.

"We are going with the ones that have the most impact first, those that would have the best outcomes for our patients right away," Ashton said. "We will be getting ready to turn some of these on in the next month or two."

She added, "Because these recommendations come from the specialty society, it really does carry a lot of value. The science behind them is very solid. So what we’re trying to do is just provide that science to the physician at the time they are with the patient."

Ashton emphasized that alerts would be a reminder, not a mandate. They will include the reasons for the recommendation, and let physicians decide based on what they know about their patients.

Some treatments and tests are prescribed just because that’s the way it’s always been done — or at the urging of patients. But as science has advanced, studies have shown they don’t improve outcomes in some cases or may even cause harm, as in the case of repeated exposure to radiation, which can lead to cancer.

The Congressional Budget Office has estimated that up to 30 percent of health care spending in the United States is unnecessary.

The Queen’s Health Systems is working to educate veteran doctors as well as up-and-coming medical residents about the Choosing Wisely effort.

"The focus of Choosing Wisely is not about saving money, it’s about reducing harm from overtesting and overtreatment," said Dr. Daniel Fischberg, medical director of the Queen’s Pain and Palliative Care Program. "We’re teaching residents about it, we’re teaching medical students about it, and we are teaching other doctors about it."

Fischberg led the national task force that produced the list of "Things to Question" for members of the American Academy of Hospice and Palliative Medicine. Earlier this month, he filled in medical students, surgical residents and doctors on the guidelines during a "grand rounds" lecture at Queen’s.

Dr. Whitney Limm, chief physician executive of the Queen’s Health Systems, was in the audience and prodded the medical students to think about what kinds of resistance there might be to such lists.

"It looks like a one-size-fits-all," ventured one surgical fellow, echoing concerns some doctors have expressed about "cookbook medicine." Fischberg emphasized that the lists are supposed to spark doctor-patient conversations based on the facts of each case.

"It’s not about getting between the patient and their doctor," Fischberg said. "It’s really about giving them the best information so that the doctor and the patient together can choosely wisely for what’s best in their individual situation."

He added, "It has to be individualized. No list can take the place of the doctor and patient working together."

Another common objection from physicians, Limm said, is the fear of getting sued if they don’t do certain tests or procedures. But talking with patients about evidence-based guidelines that reflect the consensus of their profession can help shield doctors from litigation.

"It comes back to having a dialogue with the patients," said Limm, president of the Queen’s Clinically Integrated Physician Network. "Studies have shown that poor communication is associated with lawsuits, so having better communication with patients is fundamentally important."

Kaiser Permanente was ahead of the curve when the Choosing Wisely lists came out, according to Dr. Karen Ching, Kaiser Hawaii’s associate medical director for quality and safety, and continues to keep an eye on new lists.

"As an integrated health care organization we have embraced this idea for quality care, the right care for the right patient, and avoiding duplicative or unneeded types of treatments or tests," Ching said. "It’s something that we’ve already done at KP and we’re really gratified that the broader community is also embracing the same values."

While insurers have an incentive to control costs, the Choosing Wisely guidelines are coming from doctors, not payers. The physicians decided to take the lead rather than let policymakers or payers set the agenda. In some cases, they are offering advice that runs counter to their own financial interest.

"In many cases, we’ll lose money as a hospital system by recommending not to do these things," said Hawaii Pacific Health’s Ashton. "Our physicians and our hospitals make money on some of these things.

"We’re doing it," she said, "because it’s the right thing to do."