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Choosing Wisely

The publication of a paper in the British Medical Journal this week (Wed 13th May 2015) marks the start of a major initiative, “Choosing Wisely” by the Academy of Medical Royal Colleges and its members.

In time, it is hoped the campaign will change the way medicine and medical treatments are prescribed and could have far reaching implications for the nature of healthcare in the UK as it has in the US, Canada and Australia where projects have been running from some years.

At its heart, Choosing Wisely is about encouraging both doctors and patients to have a conversation about the value of treatments. As medicine has progressed, many in the medical profession and patient representative groups, believe the trend has been to ‘over medicalise’ illness.

In Canada, for example, the Choosing Wisely project has already identified hundreds of treatments whose value should be questioned with patients. These include:

  • Exercising restraint when ordering X-rays for lower back pain, unless there indications that the pain might be a symptom of more serious illness. This can be relatively easily established by asking the patient about other factors such as whether they have lost weight suddenly or have a history of significant trauma.
  • Avoiding the use of antipsychotics as a first choice to treat behavioural and psychological symptoms of dementia
  • Not prescribing antibiotics for patients with upper-respiratory infections that are likely to be viral in origin or self-limiting such as colds and flu

While there is extensive anecdotal evidence here in the UK that clinical provision and sometimes patient expectation are increasing the demand for medical or surgical solutions, the BMJ paper argues the case for a systematic review across all medical specialties.

This work, which will be coordinated by the Academy of Medical Royal Colleges, will begin later this month with the launch of an audit, where each medical royal college and faculty will be asked to identify five treatments or tests which are of questionable value.

When those results are collated they will be analysed, assessed for accuracy and then published in the autumn of 2015. After that the Academy will launch a major public campaign to make doctors and patients aware of the list.

As in other countries where the project has started, it is expected the list will grow as the project grows.

Professor Dame Sue Bailey, Chair of the Academy said,

‘The whole point of Choosing Wisely is to encourage doctors to have conversations with their patients and explain honestly what the value of a treatment is. It’s not and will never be about refusing treatment or in any way jeopardising safety. It’s just about taking a grown-up approach to healthcare and being good stewards of the resources we have.’

Attached is a briefing on the initiative

Choosing Wisely - May 2015