Campaign to Stop Over-treatment of Patients

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A scheme to spare people from over-treatment by the NHS is being adopted by the body that represents all medical royal colleges in the UK.

The Academy of Medical Royal Colleges says too many people are being diagnosed and treated for conditions that will never cause them harm.

Writing in the medical journal, The BMJ, cardiologist Dr Aseem Malhotra, and colleagues from the Academy, explain why overtreatment is a threat to human health and a waste of resources.

The 'Choosing Wisely' initiative began in the US and has since spread to several other countries including Canada, Australia, Germany, Italy, Japan, the Netherlands and Switzerland.

This week it is the turn of the UK to try to turn the tide of too much medical intervention.

Is more treatment always better?

The Academy authors say healthcare has bred a culture of 'more is better' in which doctors feel exposed to the demands of patients to 'do something' during every appointment. "This has resulted in patients sometimes being offered treatments that have only minor benefit and minimal evidence despite the potential for substantial harm and expense," they write.

They say there is growing evidence to show that many people are being over-diagnosed and over-treated for a wide range of conditions such as  prostate and thyroid cancers,  asthma and chronic  kidney disease.

Checking for 5 dubious treatments

Health bodies which sign up to the campaign will be asked to identify 5 tests or procedures commonly used in their field which are of questionable value.

These will be compiled into lists with a recommendation that the 'top 5' interventions for each specialty should not be used routinely or at all. Doctors and patients will be helped to acknowledge that some treatments and screenings may yield little benefits, and even expose patients to harm, so that in some cases doing nothing may be a better option than doing something.

The Academy suggests that:

  • Doctors should provide patients with resources that increase their understanding about potential harms of interventions and help them accept that doing nothing can often be the best approach
  • Patients should be encouraged to ask questions such as, 'Do I really need this test or procedure? What are the risks? Are there simpler safer options? What happens if I do nothing?
  • Medical schools should ensure that students develop a good understanding of risk. Students should be taught about overuse of tests and interventions, while practising doctors should receive the same education
  • Commissioners should consider a different payment incentive for doctors and hospitals.

They conclude that it is time for action "to translate the evidence into clinical practice and truly wind back the harms of too much  medicine".

Understanding risks and benefits

Jeremy Taylor of the patient charity National Voices is welcoming the 'Choosing Wisely' campaign. "Over-diagnosis and over-treatment are not in patients' best interests," he tells us.

He continues: "People must be able to choose the treatment option that is most appropriate to them, based on a proper understanding of the risks and benefits. The evidence shows where they're involved in the decision, people will often choose less intervention. They do not ask for endless new treatments, but make appropriate – and often less costly – choices.

"People should be involved as equals in making decisions about their health care and treatment. We are therefore pleased the Academy has set this initiative in that context of shared decisions."


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