The Academy of Medical Royal Colleges is leading a new initiative in the UK seeking to tackle the underlying issues causing doctors to over-treat patients with unnecessary medical interventions.

The Academy and its partners have announced the launch of the Choose Wisely programme with a paper in the British Medical Journal, outlining the need to stop doctors from using interventions that offer no real benefit and ensure they are following best practice to make the most of available resources.

The Choose Wisely initiative, which already has similar projects up and running across the US and Canada, is asking medical organisations to identify potentially unnecessary tests or procedures, with the aim of producing ‘top-five’ lists of those with questionable value in each specialty.

This, it hopes, will encourage conversation between doctors and patients on the necessity and probable effectiveness of  interventions, such as prescribing antibiotics for patients with upper-respiratory infections that are likely to be viral or blanket x-rays for lower back pain with no other cause for concern.

Un-balanced decision-making

According to the paper, the onus is still on doctors to ‘do something’ at each consultation, which “has bred unbalanced decision-making” and often results in patients being offered treatments/procedures with minor benefit and a potential for harm. 

“This culture threatens the sustainability of high quality healthcare and stems from defensive medicine, patient pressures, biased reporting in medical journals, commercial conflicts of interest, and a lack of understanding of health statistics and risk,” the authors note.

This is further compounded by the UK’s current NHS landscape, which has no incentive to restrict doctors’ activity, they point out, arguing that the ‘payment by results’ system is in reality a ‘payment by activity’ one that encourages providers to do more throughout primary and secondary care. 

Results of the Choose Wisely audit of questionable tests and procedures for each medical specialty are to be published in the autumn of 2015, after which the Academy will launch a major public awareness campaign.