News / Royal colleges tackle over-treatment

The ‘Choosing wisely’ campaign, which already operates in the US, Canada and Australia, encourages more discussion about treatments.

‘The whole point is to encourage doctors to have conversations with their patients and explain honestly what the value of a treatment is,’ said Professor Dame Sue Bailey, chair of the academy.

A briefing from the academy said there was evidence of a ‘considerable volume of inappropriate clinical interventions’  and that patient expectation could increase demand for medical or surgical solutions. It said that over-medicalisation or inappropriate interventions delivered sub-optimal care for patients, which ‘at best adds little or no value and, at worst, may cause harm’.

While the initiative focused on quality of care, it added that ‘in a system where resources are constrained, it is unethical as well as inefficient to provide treatments or interventions that have no clinical value’. All care should be: supported by evidence; not duplicative; free from harm; and truly necessary. 

In Canada, the initiative has encouraged restraint when ordering X-rays for lower back pain, unless there are indications of more serious illness. It also discourages the use of antipsychotics as a first choice to treat behavioural and psychological symptoms of dementia and antibiotics for patients with upper-respiratory infections that are likely to be viral in origin or self-limiting such as colds and flu.