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Gold, incentives and meh

RCGP council to launch working group on overdiagnosis and overtreatment

The RCGP has set up a standing group to examine the harms of overdiagnosis and overtreatment and help inform more useful guidelines for GPs in the management of patients with multiple conditions, Pulse has learnt.

The group will be led by RCGP council member Dr Margaret McCartney and is set to launch formally in October, at the RCGP’s annual conference in Liverpool.

The standing group was approved at the last Council meeting to ‘examine and contribute to the debate on harms from overdiagnosis, overtreatment and disease mongering’.

Dr McCartney told Pulse the group will meet ‘virtually’ in between conferences to save on costs, as the College had not approved any specific funding, with a view to producing two pieces of work over the course of the next eighteen months to two years.

Key areas the group will consider are the impact of overdiagnosis and overtreatment on health inequalities, the need for policies - such as health checks and dementia screening - to consider potential harms and how to give GPs greater support to act professionally where that means ignoring harmful or unhelpful guidelines to treat patients holistically.

Dr McCartney said Somerset GP Dr Julian Treadwell will also be ‘heavily’ involved with the group, informing his work with NICE in the development of multimorbidity guidance.

Dr McCartney said: ‘We really want much more GP involvement in the way guidelines are written – at the moment guidelines are written by specialists for patients with one disease, they’re not written for real life.’

She added: ‘It’s pretty scandalous that NICE has approved a new risk threshold [for cardiovascular primary prevention] without furnishing GPs and patients with useful tools to help make those kinds of decisions, instead of scrambling around doing QIntervention – which is the 2013 version not 2014 - to try and show the risks and benefits.’

Readers' comments (9)

  • the reasons are;

    1. fear of litigation
    2. defensive medicine
    3. fear of complaints
    4. lack of support from bodies i.e. RCGP when we say no to patients
    5. fear of patient support groups
    6. fear of GMC
    7. fear of media

    there you go - saved you an expensive consultation process

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  • Don't and a you are damned by media, patients, courts and GMC. Do and you are damned by lobby groups and academics. Poor puppet coal face medical practitioners. Pick your battles.

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  • I would hold fire on criticising this initiative even though I agree that the feeling out there is reflected by the first 2 comments.
    I have the utmost respect for Dr McCartney; if you read her book and/or listen to her broadcasts (BBC Inside Health) she is frank, straight talking and EBM is mixed with honest evaluation of current mood and thinking when whe comments. RCGP council- she should be president/ chair or be declared dictator for life! ( I am not her publisher or related.)

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  • hello
    I owe the third commentator money at least
    choice is to accept the status quo
    and damn our children and relatives to a primary care service which is straining at the seams and is starting to go bust.
    start the revolution.
    the NHS cannot work without GPs. we are the risk sink,, the generalists who can take rational risks, who can manage most things given the time and resource.
    I love the NHS, and do not want it to sink ever, but not on my/our watch.
    I can't do much on my own, but lots of people calling out the current health policies as crap and the contract as harmful will eventually get listened to.
    The more people that challenge what's happening the better.
    last week I had a letter saying that it was best practice to do speculum examination on 'all women' with genital symptoms.
    this is nonsense - of course some women should be examined, but plenty of women will know they have (recurrent) BV or thrush and are safe to treat themselves and seek help if concerns.
    after lots of emails back and forward I understand this is now going to be changed. But it's such an effort and so demoralising to have to challenge this nonsense - but what if we worked together, what if the RCGP could offer advice which would start to ensure that these kinds of guidelines are written for and by generalists rather than it being done to us.
    we are being ruled by guidelines written by specialists who aren't trained in and don't work within the pressing needs of generalism.
    if you want to help the group, please email me, we will be working mainly online with position papers. Julian Treadwell, GP and I and others are also willing to come and talk to local GP groups if invited, and we plan a website with lots of resources for GPs.Lanching at the rcgp conference in Liverpool.

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  • HW

    What if the tide is turning? Could the future litigation we should be fearing, be in doing unnecessary harm? Our patients are becoming more infomred and more aware through the availability of public media of the potential harms we do. More and more often these days I'm surpirsed to hear an angry out-burst "Do you mean to say my child/father/mother has been given that tablet/antibioic for no good reason at all?!"

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  • Siraj Shah

    The driving forces behind over investigating and polypharmacy are 1. Fragmentation of care leading to “pass the buck syndrome” by consultants 2.poorly trained junior hospital doctors 3. Profiteering drug companies using academics and statisticians to push expensive newer drugs into the system
    4. Politicians and lobby groups 5. Fear of litigation if we don’t prescribe or prescribe and fail to monitor.

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  • Surely the campaign has already started? There have been conferences on 'overdiagnosis' attended by Iona Heath last president of RCGP and Fiona Godlee Editor of BMJ, conference was held in Canada in May another will be held in Oxford in September.....they do need wider representation than the same old faces at these events to widen the debate - it is younger practicing healthworkers who are going to be at the front line

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  • Interesting post 'Heather Wetherell'.

    Why are GPs so surprised, offended and feel vulnerable that patients can access the internet, books, journals, have access to medical staff etc more frequently and spend days researching medication, conditions and methods of treatment etc. than themselves??
    They have (I presume once qualified) extremely limited time for CPD whereas patient's quality of life is at risk and will therefore dedicate their life to their condition. After all their family members or friends are also often employed within the healthcare sector.
    Being prepared to misdiagnose and treat through medical ignorance, lack of time or pride is no excuse! A whole mindset need to change here to improve our patients lives... it might...just might...also help reduce litigation.

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  • The comments above are all correct! The causes and drivers of Over diagnosis are well understood by jobbing GPs and have been well described by those involved in the BMJs "Too Much Medicine" and Preventing Overdiagnosis conference. This group is not about having another consultation process to redefine the problem, but hopefully about creating meaningful change by contributing to the debate and developing resources to help us all practice in the way we want to.

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