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Bid to reduce excess medical tests

Published 13/05/2015

The Choosing Wisely scheme aims to reduce unnecessary medical treatment
The Choosing Wisely scheme aims to reduce unnecessary medical treatment

A campaign to cut down on unnecessary treatment on patients is being launched in the UK this week.

The Choosing Wisely programme aims to encourage doctors to question whether certain interventions have any real benefit to individual patients, and is being led by t he Academy of Medical Royal Colleges, which represents all 21 medical royal colleges in the UK.

The initiative, which was started in the United States and Canada to tackle over-diagnosis and the wasting of resources, has also been adopted in a number of other countries, including Germany, Switzerland, Japan and the Netherlands.

It was set up in response to a "culture of 'more is better,' where the onus is on doctors to ' do something' at each consultation," British health experts supporting the programme wrote in the BMJ.

They said this had led to unbalanced decision making and 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 a lack of understanding of health statistics and risk."

They add that the payment by results system of the NHS in England "in reality is often a payment by activity and encourages providers to do more both in primary and secondary care".

Their article highlights how a recent study revealed that when patients were told the lack of prognostic benefit for angioplasty, only 46% elected to go ahead with the procedure compared to 69% who were not explicitly given this information.

The idea of the programme is that patients should also be encouraged to ask if tests are really needed.

Participating organisations will be asked to identify 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 speciality should not be used routinely or at all.

The BMJ piece cited a recent report by the Academy of Medical Royal Colleges, which "argued that doctors have an ethical responsibility to reduce this wasted use of clinical resource because, in a healthcare system with finite resources, one doctor's waste is another patient's delay".

The academy said an audit will be carried out for each medical royal college and faculty to identify tests which they believe are of questionable value. The results will be published in the autumn and a public campaign will then be launched to spread awareness amongst doctors and patients.

Its chairwoman, Professor Dame Sue Bailey, said: "The whole point of Choosing Wisely is to encourage doctors to have conversations with their patients and about the value of a treatment.

"It's not and will never be about refusing treatment or in any way jeopardising safety. It's just about taking a grown-up approach to healthcare and being good stewards of the resources we have."

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