The overuse of diagnostic or therapeutic procedures with unproven efficacy is common in our setting and leads to increased health care costs.1 Overdiagnosis can occur due to screening tests in healthy populations without scientific evidence to support them or by requesting diagnostic tests in patients already diagnosed with a condition, which only increases risk, discomfort, and cost.2 Overtreatment arises when unnecessary, harmful, or non-beneficial therapeutic procedures are used, providing no added value.3

Quality health care is based on clinical practices with the highest benefit-risk ratio according to available scientific evidence and at reasonable costs.4, 5 Various initiatives have been undertaken to identify low-value interventions and improve appropriateness.6, 7 In 2012, the American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely campaign,8 establishing recommendations from nine societies, which have since expanded to over 500. In Spain, the Ministry of Health's Quality Plan for the National Health System9 aims to document and propose initiatives to reduce unjustified variability in clinical practice and promote the development and use of Clinical Practice Guidelines linked to Health Strategies. The GuíaSalud project10 is responsible for the methodological coordination of this initiative. Essencial,11 an initiative by the Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), identifies low-value practices and promotes recommendations to avoid them. The DianaSalud portal, developed by the Clinical Epidemiology Program of the Biomedical Research Network in Epidemiology and Public Health (CIBERESP), coordinated by the Epidemiology and Public Health Service of Hospital de la Santa Creu i Sant Pau in Barcelona (Catalonia, Spain),12 allows consultation of national and international initiatives to identify low-value interventions and improve appropriateness.13 The MAPAC initiative (Intitiative to Improve Health and Clinical Care Practices), through a defined methodology, aims to systematically analyze the appropriateness of clinical and health care services and formulate specific recommendations and actions for improvement.

In line with these initiatives, the Spanish Society of Endocrinology and Nutrition (SEEN) proposed in 2023 to draft a document compiling a series of "do not do" recommendations from its various working groups (WG) and knowledge areas (KA), aiming to identify inappropriate or low-value attitudes, services, or clinical procedures within our specialty.