Patients with sore backs should no longer have x-rays, women who are on the pill should be given a year-long supply and older people should no longer get antibiotics at the end of their lives, according to new advice drawn up by doctors.
In addition, not just children and older people but everyone should take vitamin D supplements over the winter to reduce their risk of developing colds and flu, it says.
The move could prompt claims that the health service is increasingly rationing provision in order to save money. The recommendations are part of a list of 50 tests, procedures and treatments that doctors’ leaders want the NHS to stop undertaking because they say they have little or no value and in some cases harm patients.
In some cases doing nothing for the patient might be the best thing for their health, the guidance says. Tests and treatments that have been routine for decades should either be stopped or used less often, it suggests.
The wide-ranging changes to medical practice have been proposed by the Academy of Medical Royal Colleges, which represents the UK’s 220,000 working doctors. If implemented they could save the cash-strapped NHS billions of pounds a year by reducing the unnecessary medicalisation of some ailments, the academy estimates.
The advice would give patients a much greater say in deciding how they are cared for and would lead to them being told more often about the risks and benefits of certain treatments.
“The more we learn about medicine, the more we learn about the risks and potential harms too. We have long had a tendency to over-medicalise in this country and it’s a problem that really needs addressing now,” said Prof Dame Sue Bailey, who leads the academy’s work on Choosing Wisely, a worldwide campaign by medics to improve health by reducing unnecessary medical intervention.
“Too often there’s pressure on both the patient and the doctor to do something, when doing nothing might often be the best course of action. And only when a patient is fully informed about the consequences of what’s being proposed by the doctor should the decision be made about how to proceed.”
The advice says: “Patients with low back pain do not routinely need imaging.” X-rays should be used much more sparingly because they often reveal little useful information about the origins of the pain, the academy believes.
Steve Tolan, head of practice at the Chartered Society of Physiotherapy, said: “This is excellent advice that many patients may be surprised by but is very much in their best interests. Indeed, if your doctor or physio judges that a scan is not necessary, you should take it as an encouraging sign that there is nothing serious or underlying going on.
“Often patients will see things on a scan that look terrifying and this causes them to avoid doing many of the things that will actually help, such as bending and moving in general. But commonly what they see are completely normal changes to the spine that happen over time.”
Similarly, the advice says most patients with a migraine should not undergo an MRI scan of their brain. Doctors believe that some migraine sufferers demand a scan because they fear, usually mistakenly, that they may have a brain tumour.
For diagnoses of dementia, doctors should not simply rely on a memory test, the advice says. They should also talk to relatives and carers in order to gain a fuller picture of the person’s cognitive capabilities.
The academy also advises that:
- Babies who are in the breech position before they are born should be manually manipulated by doctors back into a normal position rather than being delivered by a caesarean section.
- Older people with sight problems due to cataracts could undergo surgery on both eyes on the same day to help reduce the number of operations hospitals perform.
- Antipsychotic drugs should not be used to manage behavioural and psychological problems in patients with dementia if it can be avoided.
Imelda Redmond, national director of Healthwatch England, a government-funded patient watchdog, said patients should be helped to consider all possible options before starting their treatment.
Writing in the Pharmaceutical Journal, Bailey and Dr Aseem Malhotra, a cardiologist, say the NHS cites research by the King’s Fund that “because patients choose fewer treatments when fully informed, the NHS could save billions of pounds”.
They write: “This goes beyond a black-and-white approach of phasing out treatments that have no benefit for patients at all as more robust data becomes available, to a huge grey area in healthcare, especially in managing chronic disease where marginal benefits of treatment are weighed up against often equal risk of harm.”