Stop rou­tine tests and do less for pa­tients, doc­tors tell NHS

The Guardian - - NATIONAL - De­nis Camp­bell Health pol­icy editor

Pa­tients with back pain should no longer have an x-ray, women who are on the con­tra­cep­tive pill should be given a year’s sup­ply, and older peo­ple should no longer get an­tibi­otics at the end of their lives, ac­cord­ing to new ad­vice drawn up by doc­tors.

In ad­di­tion, every­one should take Vi­ta­min D supplements over the win­ter to cut their risk of colds and flu, rather than just chil­dren and those who are frail or el­derly, they say.

The rec­om­men­da­tions are part of a list of 50 tests, pro­ce­dures and treat­ments that doc­tors’ lead­ers want the NHS to stop car­ry­ing out be­cause they have lit­tle or no value and in some cases can harm pa­tients.

Some­times do­ing noth­ing for the pa­tient might be the best thing for their health, the guid­ance says. Tests and treat­ments that have been rou­tine for decades should ei­ther be stopped or used less of­ten, it adds.

The changes to med­i­cal prac­tice have been pro­posed by the Academy of Med­i­cal Royal Col­leges, which rep­re­sents the UK’s 220,000 work­ing doc­tors. If im­ple­mented, they could save the NHS bil­lions of pounds a year by re­duc­ing the un­nec­es­sary med­i­cal­i­sa­tion of some ail­ments, it es­ti­mates.

The ad­vice would also give pa­tients a greater say in de­cid­ing how they are cared for, and knowl­edge of the risks and ben­e­fits of cer­tain treat­ments.

“We have long had a ten­dency to over-med­i­calise in this coun­try and it’s a prob­lem that re­ally needs ad­dress­ing,” said Prof Dame Sue Bai­ley, who leads the academy’s work on Choos­ing Wisely – a world­wide cam­paign by medics to im­prove health by re­duc­ing un­nec­es­sary med­i­cal in­ter­ven­tion.

“Too of­ten there’s pres­sure on both the pa­tient and the doc­tor to do some­thing, when do­ing noth­ing might of­ten be the best course of ac­tion.

“And only when a pa­tient is fully in­formed about the con­se­quences of what’s be­ing pro­posed by the doc­tor should the de­ci­sion be made about how to pro­ceed.”

The list says: “Pa­tients with low back pain do not rou­tinely need imag­ing.” And x-rays should be used much more spar­ingly be­cause they of­ten re­veal lit­tle use­ful in­for­ma­tion, the academy be­lieves.

Steve Tolan, head of prac­tice at the Char­tered So­ci­ety of Phys­io­ther­apy, said: “This is ex­cel­lent ad­vice that many pa­tients may be sur­prised by but is very much in their best in­ter­ests.

“If your doc­tor or physio judges that a scan is not nec­es­sary, you should take it as an en­cour­ag­ing sign that there is noth­ing se­ri­ous go­ing on.

“Of­ten pa­tients will see things on a scan that look ter­ri­fy­ing and this causes them to avoid do­ing many of the things that will ac­tu­ally help, such as bend­ing and mov­ing in gen­eral. But com­monly what they see are com­pletely nor­mal changes to the spine that hap­pen over time.”

Sim­i­larly, most pa­tients with a mi­graine should not have an MRI brain scan, the ad­vice says. Doc­tors be­lieve some peo­ple with mi­graine de­mand a scan be­cause of a usu­ally mis­taken be­lief they may have a brain tu­mour.

Doc­tors should not rely on a memory test as the ba­sis for di­ag­nos­ing de­men­tia, the list adds. They should also talk to rel­a­tives and car­ers to gain a fuller pic­ture of the per­son’s cog­ni­tive ca­pa­bil­i­ties, it ad­vises.

The academy also ad­vises that an­tipsy­chotic drugs should not be used to man­age be­havioural and psy­cho­log­i­cal prob­lems in pa­tients with de­men­tia if that can be avoided.

‘Pa­tients might be sur­prised by this ad­vice but it is in their best in­ter­ests’ Steve Tolan Head of prac­tice, CSP

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