A new initiative aims to reduce the number of medical tests, treatments and procedures carried out on patients that provide no benefit or that carry an unnecessary risk.
Choosing Wisely Australia, facilitated by NPS MedicineWise and led by the medical colleges and societies, is part of a global movement to reduce inappropriate healthcare and its associated cost burden.
The idea is that consumers, doctors and other healthcare professionals can discuss care options as partners in the patient's care. Ideally, patients should feel able to ask whether tests, treatments and procedures are necessary, and how they will contribute to improved health. Doctors, equally, should feel able to refuse patient requests for unhelpful or risky tests and procedures, and discuss alternatives.
Similar programs have been operating in the US (also called Choosing Wisely) and the UK ('Do not do') for some years, with demonstrated success in reducing inappropriate practices.
The initiative will undoubtedly have flow-on benefits to Australian healthcare consumers, who'll no longer be:
- wasting their time
- spending money on out-of-pocket costs
- suffering unnecessary pain or discomfort for procedures of little or no benefit.
And by freeing up funding for procedures that do help, all health consumers benefit.
Are these procedures and tests necessary?
Among the tests, procedures and treatments recommended for questioning by doctors and patients are:
- Imaging for non-specific low back pain – unless there are indicators that there is a serious problem. Imaging doesn't help determine care, and exposes patients to harmful radiation.
- CT scans for minor head injury, which unnecessarily exposes patients to harmful radiation. Most head injuries presenting to emergency departments are minor and don't require immediate neurosurgical intervention or in-patient care.
- Long-term use of proton pump inhibitors (PPIs) for stomach acid and reflux in patients with uncomplicated diseases with well-controlled symptoms. Apart from unnecessary costs for the patient and health system, there are also adverse events such as gastrointestinal infections, pneumonia, osteoporotic fractures and nutritional deficiencies.
- Commencing medication for hypertension or high cholesterol without first assessing the absolute risk of a cardiovascular event, such as a heart attack or stroke. People at low risk won't benefit from treatment.
- Alternative or unorthodox methods for allergy testing or treatment. There are reliable tests and a range of treatments for allergy available, backed up by scientific studies proving their safety and efficacy.
- Testing for, and treating, high cholesterol in patients with a limited life expectancy.
- Prescribing benzodiazepines for anxiety or sleep problems in patients with a history of substance abuse (including alcohol) or using multiple psychiatric drugs. Adverse events in these patients include heavy sedation, coma and death.
- PSA testing for prostate cancer screening in men with no symptoms whose life expectancy is less than seven years.
The latest tests, treatments and procedures that have been flagged for questioning can be found on the Choosing Wisely Australia website. They can be viewed by medical organisation (the Royal Australian College of General Practitioners, the Australian College of Emergency Medicine etc); by the area of medicine (psychiatry, general practice, radiology etc); the name of the test or treatment; or by condition or symptom.
The website will be regularly updated as tests, treatments and procedures are reviewed.
Leanne Wells, CEO of Consumer Health Forum, welcomed the initiative.
"Choosing Wisely exposes health care to the sort of scrutiny which has too often been absent in the past. This enables consumers to have a more active role in their treatment choices – a development which research is showing improves outcomes, reduces costs and leaves both patient and clinician more satisfied."
Five questions to ask your doctor
1) Do I really need this test or procedure?
Will it help diagnose or treat the problem?
2) What are the risks?
What are the side effects or risks that the results aren't accurate?
3) Are there simpler, safer options?
Are there lifestyle changes you could make instead?
4) What happens if I don't do anything?
Will your condition get worse, stay the same or even improve if you don't act straight away?
5) What are the costs?
Apart from financial costs, there may be emotional costs, or the cost of your time. Are there cheaper alternatives?
Download a PDF of these questions to take with you when you go to the doctor.