Campaign to reduce the harms of too much medicine comes to the UK
- Patients should be encouraged to ask if tests are really needed
- Doctors should discuss potential harms of treatment with patients
- Experts will develop lists of common practices that should be stopped
A US initiative to get doctors to stop using interventions with no benefit is being launched in the UK this week.
The Academy of Medical Royal Colleges, which represents all medical royal colleges in the UK, is launching a Choosing Wisely programme in partnership with specialty organisations, including The BMJ, to help tackle the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care.
In The BMJ today, Dr Aseem Malhotra and colleagues set out the aims of the project and explain why doing nothing can often be the best approach.
Unnecessary care occurs when people are diagnosed and treated for conditions that will never cause them harm, and there’s growing evidence that many people are overdiagnosed and overtreated for a wide range of conditions such as prostate and thyroid cancers, asthma, and chronic kidney disease.
Participating organisations will be asked to identify five tests or procedures commonly used in their field, whose necessity should be questioned and whose risks and benefits should be discussed with patients before using them.
These will be compiled into lists, and the “top five” interventions for each specialty should not be used routinely or at all.
So far, more than 60 US specialist societies have joined the Choosing Wisely initiative, say the authors. It has also been adopted by other countries, including Australia, Germany, Italy, Japan, Netherlands and Switzerland - a clear sign that wasteful medical practices are a problem for all health systems.
A culture of “more is better,” where the onus is on doctors to “do something” at each consultation has bred unbalanced decision making, argue the authors. “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.”
This culture threatens the sustainability of high quality healthcare and stems from defensive medicine, patient pressures, biased reporting in medical journals, commercial conflicts of interest, and lack of understanding of health statistics and risk, they add.
Rather than focusing on a system of payment by results - which encourages doctors and hospitals to do more - they suggest that guideline committees “should increasingly turn their efforts towards the production of tools that help clinicians to understand and share decisions on the basis of best evidence.”
They acknowledge that shared decision making “does not guarantee lower resource use” and that reducing wasteful and harmful healthcare “will require commitment from both doctors and patients, in addition to objective evidence of effectiveness.”
But they say it is time for action “to translate the evidence into clinical practice and truly wind back the harms of too much medicine.”
Katharine Jenner, Chief Executive of Blood Pressure UK, said: “There is no better treatment for raised blood pressure than prevention – the sooner you can find out what your blood pressure is, and to take steps to reduce it, the better. Simple changes such as eating less salt, losing weight, eating more fruit and vegetables and taking exercise have been proven to reduce blood pressure and lower your risk of having a stroke or a heart attack.
“However, it is very important to note that anti-hypertensive treatments are undoubtedly lifesaving, responsible for thousands fewer deaths from strokes and heart attacks, caused by raised blood pressure – both mild and severe - each year. If you have been prescribed it by your GP, do not stop taking it without speaking to him or her first, or you could be seriously endangering your life.”
Notes to Editors:
Analysis: Choosing Wisely in the UK: Academy of Medical Royal Colleges’ initiative to reduce harms of too much medicine
Journal title: The BMJ
For further press enquiries please contact Max Prangnell, communications advisor to the Academy on +44 (0)773 436 1055.
Author contact:
Dr Aseem Malhotra, Cardiologist and Consultant Clinical Associate to the Academy of Medical Royal Colleges
Tel: +44 (0)7786 075 842
Email: aseem_malhotra@hotmail.com
For more information, visit: http://www.bmj.com/cgi/doi/10.1136/bmj.h2308