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GPs are 'overdiagnosing and overtreating older patients'

GPs are overdiagnosing and overtreating elderly patients, concluded a vote by delegates at the Pulse Live conference in London today.

Delegates agreed by a huge margin - estimated to be around 90% of the room by conference chair Professor David Haslam - that GPs were overtreating elderly patients, with expert practitioners and academics highlighting the problem raised by treating risk factors rather than symptoms.

Speakers stressed the need for in-depth consultations that looked at social interventions as well as prescribing medications, and proactively discussing end-of-life care and the pros and cons of treatment with patients.

The debate follows changes to the GP contract, which involve each patient over the age of 75 being designated a named clinician, and a consultation from NICE on prescribing statins, which proposed that the primary prevention threshold for prescriptions should be halved from 20% to 10%.

There have also been recent revision to the dementia DES, which enabled GPs to exercise more clinical discretion in referring ‘at risk’ patients for dementia screening.

Dr Linda Patterson, consultant in general and geriatric medicine – arguing for the motion - said that older patients needed to be treated holistically and that hearing aids and other interventions could improve a patient’s quality of life as much as correctly regulated cholesterol.

She added that GPs should having longer, in-depth discussions with older patients to explain risks early on, and that this could potentially save repeat appointments to discuss medications.

Professor Peter Crome, professor emeritus of  geriatric medicine - arguing against the motion – stressed that doctors shouldn’t let the fact that their patient was older affect how they opted to treat them, and argued the motion assumed that treating older people was ‘not worth it’.

He conceded that there remained a problem of what interventions were effective because of ‘the paucity of clinical trials in older people, especially those with comorbidities’.

Also supporting the motion Surrey GP Dr Martin Brunet called for NICE guidance to be clear that GPs could use their discretion and to emphasise the need for patient choice in treatment decisions.

Readers' comments (9)

  • 90% is a very high percentage.

    But as a specialist in older adult psychiatry I am not at all surprised.

    I am not a GP, but it occurs to me that "over-diagnosing and over-treating" is a risk when targets, often incentivised, are placed ahead of individual patients and truly informed consent.

    Add in tiers of check-boxes and reminders that are triggered by algorithms; alongside our genuine fear as healthcare practitioners of the consequences of departing from "Guidelines"... well, no wonder our elderly are being over-treated.

    Large-scale interventions and improvements, well-intended as they are, have diluted professional discretion. As Dr Brunet has said : it is time that we gave the consultation back to our patients.

    The next "epidemic" (and this is not a word I want to use) is well underway and that is the over-diagnosis of dementia. Culturally have we now entered what Stephen G. Post once feared: a "hyper-cognitive Society"? I think so.

    This approach risks heightening fear in our respected elders (well, in my view, to a disproportionate level).

    Un-intentional stigma may be promoted by over-diagnosing cognitive "otherness" in our elders.

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  • Vinci Ho

    Let's face it , both NICE and QOF have fallen into the fallacy of one size fits all. I accept the fact most trial results are based on younger populations and hence would have cast uncertainties in senior elderlies(age >80, for instance) . These patients need a different and pragmatic approach . Benefit against risk concept is even more important but GPs have been put on an almost impossible position . Patients still look up to their GPs to make a decision and have faith in them.
    An HBA1c of 53mmol/mmol(7%) is important in a 60 years old where as 64 mmol/mmol(8%) is more logical in a 83 years old. Yes , this may not be evidence based medicine but like everything , there is always a limit of knowledge . Only common sense can prevail.......

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  • Don't blame the GPs.Blame QoF;blame those ivory tower pen-pushers who keep imposing their very flmsy evidence based guidelines;blame the over litiginous society;blame the politicians responsible for the current mass exodus of experienced GPs.And please stop this endless GP bashing.We just cannot win!

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  • Dr Mustapha Tahir

    And do not forget what unwanted poly pharmacy is doing to our senior citizens. @Mustapha Tahir

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  • There was a certain amount of disquiet expressed in BMJ rapid responses over the fact that an article on 'overdiagnosis' was repeated one week after another in BMJ. Fiona Godlee , Editor of BMJ is in a position to promote this campaign in the BMJ but there is no mention of her involvement in the campaign which is taking place . The second conference 'preventing overdiagnosis' is taking place in September if anybody has approx. £300 attendance fee to spare - Fiona declared last years conference as one of the best she has attended so it would have been appropriate to mention in the BMJ that it is taking place

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  • I don't think we can blame QoF et al. Who would treat an elderly patient if they thought it was going to cause more harm than good? Aren't these judgement calls we make every day?

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  • high patient expectations + low threshold to complain + threat of legal action + targets = defensive medicine.

    we're seeing it not only in older patients but across the board.

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  • On the other hand we are told you can't discriminate due to age!

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  • I wonder what these folk think GP's did during their years of training?
    Do they really think GP's are so stupid they are not aware of the risks / needs of any patient, that they need a pen pusher to keep telling them how to do their job?

    GP bashing appears to be a new from of career fro folk who haven't the talent or skills to find something better to do.

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