Just because we can do it, doesn’t mean we always should.
That’s the gist of new advice from the Academy of Medical Royal Colleges, which has listed 40 common treatments which actually bring little or no benefit to patients. It had drawn up the list as part of a campaign to reduce the number of unnecessary medical treatments each year, which could result in massive savings for the NHS.
It is also keen to highlight to patients that more doesn’t always mean better when it comes to treatment. Many of the procedures which patients have come to expect actually have no significant medical benefit, and some could even have downsides. In some cases, they are given to provide mental reassurance for a patient rather than any medical benefit.
Among the unnecessary treatments listed by the Academy are:
· X-rays are of no real help to people with lower back pain
· Chemotherapy might be used to relieve some of the symptoms of terminal cancer, but it cannot cure the disease and could bring further distress in the final months of life
· Electronic monitoring of a baby’s heart is only needed during labour if the mother has a higher-than-normal risk of complications
· Children with bronchiolitis, or breathing problems, usually get better without treatment
· Tap water is just as good for cleaning cuts and grazes as saline solution
· Routine screening for prostate conditions using a test known as Prostate Specific Antigen (PSA) does not lead to longer life and can cause unnecessary anxiety.
· Small wrist fractures in children do not normally need a plaster cast and will heal just as quickly with a removable splint.
The list is part of the Academy’s ongoing ‘Choose Wisely’ campaign, which encourages both doctors and patients to talk frankly and at an early stage about how health issues should be treated. The list was compiled by asking medical experts from 11 different specialities to identify five treatments or procedures commonly used in their field which were not always necessary or helpful. It is intended that the list will be added to over time.
One key area is the routine prescribing of antibiotics for conditions which will clear up just as quickly without them. Over-prescription is leading to many commonly used drugs becoming less and less effective as viruses adapt to resist them. Yet many patients have come to expect and demand antibiotics for a range of conditions where their medical benefit is questionable.
According to the Academy there is evidence that patients often pressurise doctors into prescribing medicines or carrying out unnecessary treatments and sometimes become antagonistic if they are withheld, even on sound medical grounds. It wants patients, or carers of patients, to be more realistic about what treatments are really needed and what benefits they will bring.
As well as urging clinicians to question the benefits of some treatments, the Choose Wisely campaign encourages patients to play a proactive role in their treatment. It says patients should always ask the following five key questions when seeking treatment:
1. Do I really need this test, treatment or procedure?
2. What are the risks or downsides?
3. What are the possible side-effects?
4. Are there simpler. Safer options?
5. What will happen if I do nothing?
Professor Sue Bailey, chairwoman of the Academy of Medical Colleges, said: "We’re asking for a shift in the conversation between the doctor and the patient from not ‘what can we do?’ to ‘what should we do?’
“Some of these treatments can be quite invasive and time-consuming; there are simpler and as-safe options, so why wouldn't you? We need to stop and reflect and decide what is the best option for the patient in their individual circumstances."