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Royal Colleges urge patients to question GPs over tests and treatments

Patients should question their GP about the harms and benefits of tests and treatments they’re being prescribed, according to the Academy of Medical Royal Colleges.

The new guidance forms part of the Academy of Medical Royal Colleges' Choosing Wisely programme, which launched in 2015 to reduce over-medication.

The academy has also published a list of 50 procedures that they consider to have little value, adding to the 40 avoidable interventions that they published in 2016.

GPs leaders have said that while they support the premise of patient empowerment, it's important to be realistic about the time this will take and called for longer patient consultations if this guidance is to be implemented. 

The academy, which includes the RCGP among its 24 members, has set out to encourage patients to question their GP about what they are being prescribed.

The guidance has said that patients should be told to ask their GP what the benefits, risks and alternatives are, as well as what will happen if nothing is done.

Professor Dame Sue Bailey, the Academy of Medical Royal Colleges’ Choosing Wisely campaign lead, said: ‘Too often patients just accept what a doctor is telling them without question.

‘We want to change that dynamic and make sure the decision about what treatment is taken up is only made when the patient is fully informed of all the consequences.'

However, Dr Uzma Ahmad, Walsall LMC medical secretary, said: ‘Discussing the treatments in length would require longer consultations. If the patient expectations are too high and they think that every treatment will be discussed in detail, we have to be really realistic about the time this will take.’

She added: ‘We can’t just be given recommendations if we can’t act on them. We need more time with the patients.'

Doncaster LMC chief executive and GP Committee representative Dr Dean Eggitt said: 'Whilst I support the premise of these questions I think the application of the idea as applied by the academy is going to lack the impact we need.’ 

He added: 'Rather than empowering patients to question, challenge and understand years of postgraduate medication education, I would far rather we empower them to understand the basics of how they themselves function and dysfunction.

‘To this end, we may then reduce unnecessary encounters with clinicians and do away with the need for some of these questions altogether.'

It follows a study of over two million patients in England, found that patients value GP quality of care - including explaining tests and treatments and involving patients in decision making - more than the ease of access to their practice.

The academy has also added 50 further recommendations to its list of interventions that doctors should avoid or replace with a simpler alternative, bringing the total number to 90.

This follows a two-year consultation with senior doctors from the UK’s medical royal colleges and patient representatives. 

NHS England has launched its own guidance on conditions for which over-the-counter medicines should not be prescribed.

The Academy of Royal Medical Colleges' recommendation include:

  • Encourage everyone to take vitamin D supplements in the winter, not just the frail and the elderly
  • Extend the period the contraceptive pill is prescribed for women to reduce visits to the GP
  • Discuss the use of antibiotics at the end of life with patients and their family
  • Review the use of antibiotics for patients with bacteria in their urine who have no, minimal, non-specific, or long-standing urinary symptoms
  • Review the use of antibiotics for conditions that are not infections
  • Not routinely image patients with suspected migraine
  • Not use drug treatments to manage behavioural and psychological problems in patients with dementia if they can be avoided

Source: Academy of Royal Medical Colleges

Readers' comments (14)

  • Took Early Retirement

    Er....as a GP I always tried to do this.

    However, some of the rest of it is just so BLOODY silly. Like, well, we KNOW you don't image for migraine routinely, and you DON'T use antibiotics for "conditions that aren't infections" except in very unusual circumstances.

    Some of these "ex-cathedra" statements are just GCSE level Medicine!

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  • Sounds like the good folk at the Academy are trolling GPs.

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  • Ahem, speaking as a Gp, I have rarely encountered communication problems at this level, however, sadly I must report that the highly invasive tests frequently ordered by some of my comsultant colleagues are sometimes obfuscated with the patient regarding the inherent dangers of some of these investigations, imho the more invasive/ dangerous a test becomes the more explanation is required.

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  • Perhaps secondary care should do the same, advise us they have done so when they tell us to start something (they forget we can decline)

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  • Vinci Ho

    Established in 1974 as the Conference of medical Royal Colleges and their Faculties, it was renamed the Academy of Medical Royal Colleges in 1996.

    Always wonder why there was a necessity to have another layer of bureaucracy for all these royal colleges which should have enough independence to stand alone.
    Anyway , are you familiar of the label ‘egghead scholars’?
    They used this term often in the media in the Far East (Hong Kong, Taiwan etc) 蛋頭學者

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  • So.
    I’ve seen a colleague ( not this area) pilloried for no mri brain even when the neurologist who the patient was referred to requested an mri just in case, saying they thought it was just migraine. Was a sol.

    My mother died of dementia more agitated and upset than she could have been , because doctors ( I don’t blame them fo one second ) were afraid to use drugs on her.

    Depressing garbage from the royal colleges as ever.

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  • AlanAlmond

    We ready know all this and do it already, if we can and have time, it’s just good practice.

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  • Once again clinicians are told by someone who does not or hardly sees any patients what to do. We are already doing this and we only have 10min. If the test is not done you are criticised for missing things. If it is done you get this BS. We are adults and can jolly well manage our clinical risks thank you. Sue Bailey, please see some patients and show us by example how your 3h surgery turns into 6h just by spending 10min extra per patient.

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  • I consider the Royal College as a very able and knowledgable society, GPs are already doing this where required, however if GPs have to discuss the medication in some detail with each and every patient, they must have at least 20 minutes consultation time.

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  • The 'Royal' should be removed from the Academy of Colleges as it belittles and brings shame to royalty. They aren't 'royal' anymore, just a piece of stinking shame to the professions they goad.

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