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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.