Medical chief: Quarter of NHS diagnostic tests not needed
Call for end to over-treatment of patients and ‘honest conversations’
A QUARTER of diagnostic tests carried out by the NHS in Scotland are “not appropriate or necessary”, the country’s chief medical officer has said as she called for a shift away from over-treatment.
Dr Catherine Calderwood said the “doctor knows best” culture should give way to “shared decisionmaking and reducing harmful and wasteful care”. This included having “honest conversations” with terminally ill patients who may prefer not to undergo any treatment at all, she said.
She said: “Not all people will want the same thing, nor should they. There will be a wide range of views. However, an important context for this work is that in surveys of NHS patients over a number of years more than one-third of people we care for and support have consistently told us they would like more involvement in decisions about their care.”
The report, Realising Realistic Medicine, is Dr Calderwood’s second as Scotland’s chief medical officer. She added: “The year-onyear increase in diagnostic testing activities and associated costs that has been observed and the sevenfold variation in requesting rates for some diagnostic tests further underlines the need for a broader range of professions within NHS Scotland to identify innovative ways of examining any unwarranted or harmful variation.
“Approximately 25 per cent of diagnostic tests undertaken are not appropriate or necessary.”
Dr Calderwood pointed to the landmark Supreme Court ruling against NHS Lanarkshire in 2015 in a case brought by Nadine Montgomery, who was awarded £5.25 million compensation after successfully arguing doctors had neglected to give her proper advice that may have led to her son, Sam, having a safer caesarean birth in 1999. He suffered brain damage during the delivery.
Dr Calderwood said: “The judgment emphasises that discussing risk is not about potentially overwhelming people with information covering every conceivable risk. It is about having a meaningful, clear conversation and coming to a shared decision.”
Professor Derek Bell, president of the Royal College of Physicians of Edinburgh, welcomed the report, adding: “Issues such as the overuse of clinical treatments, interventions and antibiotics remain high on the College agenda.”
However, Dr Peter Bennie, chairman of the British Medical Association Scotland, said the “ever increasing demand and high levels of long term vacancies” within the NHS meant many doctors “do not have the necessary time” with patients.
Dr Calderwood said a citizens’ jury and panel will be formed early this year to gauge public views on healthcare.
The report also highlighted Scotland’s continuing battle with alcohol, with sales of alcohol about 20 per cent higher in Scotland than in England and Wales and rising since 2013. It adds: “Levels of alcohol-related harm remain unacceptably high in Scotland: there are around 22 deaths on average per week due to alcohol misuse, and an average of 674 hospital admissions per week.