The UK version of the US Choosing Wisely campaign was launched this week. The aim of the campaign is to reduce wasteful medical practices. The campaign was launched by the Academy of Medical Royal Colleges which published an accompanying briefing document. An article in the BMJ was published to coincide with the launch.
Choosing Wisely asks medical organisations (such as medical royal colleges in the UK) to identify "tests or procedures commonly used in their specialty, the necessity of which should be questioned and discussed". These are compiled into lists, and the “top five” interventions for each specialty should not be used routinely or at all.
This is a great initiative but the obvious question to ask is, why should we need this campaign? Why would doctors be making diagnoses, ordering tests and prescribing treatments for us that have been proven to do no good at all and, in many cases actually do harm, especially when resources are stretched?
The Academy’s own rationale is revealing:
There are two key forces that have allowed this situation to develop. The first is the way healthcare is paid for and the second is the weak position of the consumer or patient.
For a generation healthcare has been paid for based on activity, providing little incentive for clinicians to focus on the appropriateness of care. Doctors get paid for doing more, not less. With Accountable Care in the USA and Clinical Commissioning Groups in the UK, this is changing, albeit slowly.
Patients are generally not well informed about their health and have a poor understanding of risk, particularly the difference between absolute and relative risks, coupled with the fact they are often feeling weak and vulnerable at the time they are having to make decisions about their treatment.
As the BMJ article states, “Diagnosis drives treatment” and so we are back to the issue of how the patient becomes sufficiently informed about his/her diagnosis to challenge their doctor? I believe that this again demonstrates how the Isabel symptom checker is a key tool to enable patients to become better informed. Patients are the experts on their symptoms and how they have changed over time. The symptom checker helps them research what they could mean and what they should be asking their doctor.
The need for a Choosing Wisely campaign simply shows that patients cannot leave decisions about their diagnosis and treatment solely up to their doctors and should be aware that the incentives in the health system still encourage many doctors to over test and treat.
Thankfully, in the UK we are not at the absolute levels of over treatment seen in the US but we still show wide variations in the use of medical and surgical interventions and are certainly not at the level you would expect with a single payer national health system. For a US perspective it is timely that The New Yorker magazine has just published another wonderful essay on this very topic by Atul Gawande entitled “Overkill”. He agrees that patients should get more informed but it's not an easy task.
Jason is the CEO and Co-founder of Isabel. Prior to co-founding Isabel, Jason spent 12 years working in finance and investment banking across Europe. His daughter, Isabel, fell seriously ill following a misdiagnosis in 1999 and this experience inspired Jason to abandon his city career and create Isabel Healthcare Ltd.