Doctors urged to stop 'over-treating'

Pills Image copyright BBC Horizon

Doctors' leaders have launched a major campaign to stop medics "over-treating" their patients in ways that do not help and could even harm them.

Writing in the British Medical Journal, they suggest some patients are given pills or have tests they do not need by doctors who feel under pressure to act.

They argue patients should feel able to discuss whether there are simpler, safer options that are right for them.

But experts warn they must not change treatment without medical advice.

'Grown-up approach'

The Academy of Medical Royal Colleges (AoMRC) says there is growing evidence that pressure for doctors to "do something" at each consultation has led to patients sometimes receiving treatments that are of little or no value.

And the report suggests a culture of "more is better" means some individuals are being over-diagnosed - labelled with conditions that may in the end do them little harm.

Launching the Choosing Wisely campaign, experts are calling on medical organisations to identify five procedures each that should not be offered routinely or in some cases not at all.

These might include:

  • Pills for mild depression
  • Too many routine and unnecessary blood tests
  • Medicines for mildly raised blood pressure

Prof Dame Sue Bailey, a leading psychiatrist and chair of the AoMRC, argues many patients with mild depression could instead be offered group exercise classes or talking therapies first.

And she says frequent blood tests can be particularly distressing for elderly people with frail skin.

She also argues that for some patients with mildly elevated blood pressure, changing their lifestyle might be the most appropriate initial option.

But other experts defend the use of these pills in mild, moderate and severe cases and the charity Blood Pressure UK warns patients should consult their doctors before changing their medicine.

And the Brain Tumour Charity says this type of initiative must not come in the way of doctors ordering the right tests for serious but sometimes uncommon conditions.

The organisation argues for some patients with cancers, their initial, general symptoms are overlooked and not investigated quickly enough.

Changing evidence

Nevertheless, as science advances and the evidence shifts, experts say individuals should be encouraged to check whether procedures are definitely right for them.

For example, patients are advised to ask:

  • Do I really need this test or procedure?
  • Are there simpler options?
  • What happens if I do nothing?

The campaign is already under way in Canada and the United States.

And while experts acknowledge that asking doctors to change familiar practices could be controversial, they say it is worthwhile if it leads to better care.

Dr Aseem Malhotra, heart specialist and author of the report, said: "Over-diagnosis and over-treatment are the products of a broken system.

"For the sake of our patients there needs to be a radical overhaul in culture so we can provide the best quality care."

Prof Bailey added: "It is not and will never be about refusing treatment or in any way jeopardising safety.

"It is just about taking a grown-up approach to healthcare and being good stewards of the resources we have."

And Jeremy Taylor, of the patient charity, National Voices, welcomed the initiative.

He said: "The evidence shows where patients are 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."

Experts plan to evaluate each suggestion before publishing their list later this year.

But as their article points out, there is no guarantee that this approach will necessarily reduce the use of unwarranted and sometimes harmful tests.

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