Campaign against “too much medicine”

A CULTURE of over-treatment amongst medical professionals is leading to poor care and even patient harm, the Academy of Medical Royal Colleges has said.

Some patients may be given pills or have tests they do not need because doctors feel pressured to act.

These views emerged as the AoMRC launched its 'Choosing Wisely' initiative which aims to reduce levels of unnecessary medical interventions in the NHS.

In a briefing document, the Academy said it believes there is evidence of “a considerable volume of inappropriate clinical interventions” which form part of a culture of “over-medicalisation”. It said this results in sub-optimal care for patients “which, at best, adds little or no value and, at worst, may cause harm.”

This culture, the Academy said, stems from defensive medicine, patient pressures, biased reporting in medical journals, commercial conflicts of interest, and a lack of understanding of health statistics and risk.

The goal of Choosing Wisely, recently developed in the US and Canada, is to change the way doctors practise “by getting them to stop using various interventions that are not supported by evidence, free from harm, and truly necessary”. This includes treatment that duplicates tests or procedures already received.

Lists of the most common tests or interventions “with questionable value” will be drawn up by the AoMRC and other organisations supporting the scheme. These might include: pills for mild depression, too many routine and unnecessary blood tests, and medicines for mildly raised blood pressure. Doctors would be asked to think carefully before using these to ensure they are necessary, and to consider alternatives such as exercise classes or talking therapies.

Doctors are also encouraged to make decisions that take into account individual patient circumstances, patients’ wishes, clinical expertise and available resources. They should encourage patients 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?

RCGP chair Professor Maureen Baker welcomed the initiative but said greater public awareness of treatment options was needed.

“Cutting down on inappropriate interventions is in everyone’s best interests – for example, the NHS using fewer antibiotics will be beneficial for wider society by resulting in lower resistance to antibiotics,” she said.
 
“However, family doctors are often under considerable pressure to prescribe, or take some form of action, as a result of a patient consultation, so it is important that we work together to make people realise that drug or surgical treatment isn’t always the best way forward.”

GPC clinical and prescribing subcommittee chairman Dr Andrew Green supported this view.

He told GPonline: “[F]or this initiative to really have impact the underlying causes of overtreatment and over-investigation need to be addressed, and these include fear of litigation, intolerance of uncertainty, worry about critical comments on NHS choices, and specialist-dominated guidance.”