It is time for action to translate the evidence into clinical practice and to truly wind back the harms of too much medicine
A group of senior doctors published an article in the British Medical Journal last week announcing that the Academy of Medical Royal Colleges is to launch a nationwide “Choosing Wisely” campaign in collaboration with other healthcare organisations, including the NHS. The campaign is based on Choosing Wisely initiatives already underway in the US, Canada, Germany, Italy, Japan and the Netherlands, and aims to stop the growing trend in the UK of “over diagnosis” and “over treatment” of patients, which according to the experts is unnecessary, expensive, and often does more harm than good.
The BMJ article criticises “over-diagnosis”, referring to the trend of doctors rushing to diagnose patients with conditions that will often never cause any symptoms or harm, and “overt reatment”, defined as treatment that “has minimal benefit or is excessive in complexity, duration or cost relative to alternative acceptable standards”. According to senior doctors these two trends have grown in tandem the UK in recent years. The authors of the article blame this phenomenon on the mechanisms through which doctors are paid in the UK: for example UK hospitals are paid based on the number of patients they treat, and the pay of GPs is also linked to the prescription of certain drugs and checks for conditions such as diabetes. This phenomenon has lead to “a system of payment by results, which in reality is often payment by activity”, according to members of the Academy.
This system of over diagnosis and over-treatment, as well as being inefficient financially, can also cause harm to patients, for example through prescribing medication for slightly raised blood pressure that has very little impact on the condition but can cause damaging side effects. It is said that often Doctors are not frank enough with patients about the realistic likelihood of success or varying outcomes of surgery, and this often leads to interventions that cost money to the NHS and pain to the patient, with very little gain.
Following in the footsteps of the Choosing Wisely campaign in the US the campaign will work with different organisations to raise awareness of the danger of over treatment, create resources for doctors and encourage a much more open dialogue between medical staff and patients regarding risks and benefits of treatment. The first action of the campaign will be to create a list of tests or treatments of “questionable value” (see here for the US version). Each medical royal college will be asked to contribute five treatments, and the final list of approximately one hundred interventions to avoid will be circulated around the UK.
The campaign argues that it is motivated by a desire to increase standards of care for patients and improve patient-doctor communications, but the initiative is also concerned with saving money within the NHS, which the article says will be “crippled” if expensive, unnecessary treatments persist at their current rate. This emphasis on saving costs has raised concerns with charities and patient support groups however, such as The Patients Association, a charity that campaigns for improved pt care throughout the UK. Quoted in the Guardian earlier this week the charities chief executive said:
“We acknowledge the NHS has to balance the books, but that should not be at the expense of treating patients appropriately. I would be very concerned that a GP or hospital doctor might think twice about whether ordering an investigation for the patient to get a diagnosis, such as a scan or x-ray, is “needed” or not”.
The full article can be accessed on the British Medical Journals website.
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