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Gold, incentives and meh

GPs to develop list of unnecessary interventions under scheme to tackle overtreatment

A group of royal colleges including the RCGP is launching a new initiative to tackle overuse of unnecessary drugs and procedures that they say are doing more harm than good.

Led by Dr Aseem Malhotra, from the Academy of Medical Royal Colleges, the ‘Choosing Wisely’ campaign will encourage GPs to discuss potential harms of treatments with patients, as well encouraging patients to ask if tests are really needed.

By autumn, each of the colleges will submit a list of the top five tests or procedures that are of ‘questionable value’ and will advise doctors on stopping using them.

The move comes after a team of GPs, led by RCGP Council member Dr Margaret McCartney, set up a working group on over-medicalisation.

Professor Maureen Baker, chair of the RCGP, said: ‘If there is evidence to show that a particular intervention might be of little benefit to a patient, it is good practice that alternatives are explored.’

She added that GPs were ‘under considerable pressure to prescribe, or take some form of action’ so it will be important to work together with people so they ‘realise that drug or surgical treatment isn’t always the best way forward’.

BMJ 2015; available online 12 May

Readers' comments (23)

  • Read Margaret McCartneys book I found it well written and a good read as well as generating about 20hours CPD including impact.
    Stop PSA, breast screening, cervical screening, NHS health checks, acupuncture, homeopathy, statins for primary prevention.
    None of this will be popular with the electorate, therefore it will not happen.

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  • We need to review the way we assess risk and benefit. Relative risk reduction (RRR) is a poor discriminator. We should always consider absolute risk reduction (ARR). Thus a 50% risk reduction (RRR) sounds great but if it is actually a change from 2 per million to 1 per million (ARR of 1 per million) it doesn't look so impressive. Many of the interventions supported by CCT have quite modest ARR even though RRR is impressive.

    Quite why it has taken the great and good so long to draw attention to this fairly obvious point is an equally important question to ask. Did they just swallow everything produced by the EBM lobby without thinking about it? If so what are they doing in their "influential" positions and how did they ever get there? I hope someone will ask them.

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  • increased risk + litigation = defensive medicine ...

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