Doctors treating us too much, campaign says
Campaigners want patients and doctors to understand the risks of over-diagnosis and over-treatment of illnesses. Do we have unrealistic expectations of the potential of medicine?
The patient walks in. Something seems to be wrong, but it isn’t clear how severe it is. The doctor has several options, but only 10 minutes to establish the problem and judge what to do. Worried about the possible consequences of inaction, they prescribe medicine or refer the patient for treatment.
This is what the ‘defensive medicine’ culture looks like: doctors try every test or treatment available to them to avoid being accused of putting a patient at risk. It’s the central problem highlighted by the Academy of Medical Royal Colleges (AoMRC) in advance of this week’s UK launch of the Choosing Wisely campaign. Those behind the campaign say that a range of ailments unlikely to lead to symptoms or death are regularly over-diagnosed or over-treated. Research conducted for the British Medical Journal in 2012 suggested, for example, that up to one third of breast cancers may be being treated out of proportion to the potential harm they could cause.
The campaigners, following similar movements abroad, say that patients’ demands, NHS payment systems and clinical guidelines currently encourage doctors to diagnose and treat problems unnecessarily, causing many patients to suffer avoidable side-effects and require follow-up treatment. They add that using expensive procedures and treatments is placing strain on NHS resources and the overuse of medication encourages people to think that medicine will always be able to provide cures for their ailments, suggesting that there is no need to take responsibility for their own health. They say that lifestyle changes, such as exercising regularly, may be more effective than medical treatment in many cases.
Dr Aseem Malhotra, a cardiologist and consultant clinical associate to the AoMRC, calls these problems ‘the greatest threat’ to the NHS. But the problem has a long history; the campaigners cite the example of King Hammurabi, who ruled Babylon in the 18th century BC and threatened surgeons with losing a hand or an eye for performing unnecessary treatment.
Choose your poison
The doctors suggest that we have come to expect too much from them. We’ve come to think that a pill or an operation will make an illness go away. It’s up to us; there needs to be much more emphasis on what we can do to stay healthy. And even if we exercise, eat well and avoid unhealthy habits, medicine is always destined to fail eventually.
But perhaps over-treatment is just a natural part of being human. We will always worry about our health, particularly our mortality. Even if people become better informed, they will still want to feel in control of these things. And when we go to the doctor, we expect to be given clear solutions to our problems.
- Would you mind if a doctor told you to change your lifestyle, rather than giving you a prescription or referral, to get better?
- Are we too used to the idea that medicine has easy answers to our problems?
- In a group, make a presentation showing ways in which you can keep healthy, and the impact that your own actions have on your body.
- Write a letter from a doctor to a patient explaining why you are not giving them the treatment that they asked for. If possible, research a specific illness and treatment to use.
Some People Say...
“Doctors should do what we ask them to do.”
What do you think?
Q & A
- So should I trust what my doctor says?
- Doctors in the UK are very well-trained and respected. But as they are human, they are fallible and they often face great pressure, so they won’t get everything right. The campaign isn’t saying ‘don’t trust your doctor’; it’s encouraging doctors and patients to ask more questions rather than diving straight for a prescription or operation. Their point is that the human body is very complex, so don’t expect easy solutions when it malfunctions.
- How does this affect us when we’re not ill?
- It means that money and the doctors’ most precious resource — their time — are being wasted. In some cases, the over-treatment is creating more problems for the patient than doing nothing; in others, it’s just not doing enough good to justify the effort.
- The Choosing Wisely campaign
- The campaign calls for doctors and patients to be given more information about the advantages and disadvantages of potential treatments, patients to be encouraged to ask questions about their treatment, medical schools to teach about the problems, and payment systems to change.
- Range of ailments
- Inspired by similar work overseas, medical organisations in the UK are identifying treatments which patients and physicians should question, including prescriptions of antibiotics when a viral infection is the likely problem, excessive scans for minor injuries and unpleasant treatments unlikely to improve the quality of life of terminally ill patients.
- NHS payment systems
- The campaigners are critical of the system of payment by results, which they say encourages doctors to find illnesses and prove that they have been treated without considering what might be best for the patient.
- Clinical guidelines
- Campaigners want doctors to apply the guidelines, from the National Institute for Health and Care Excellence (NICE), more loosely according to circumstances.