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