Intended for healthcare professionals

Feature Shared Decision Making

Can doctors reduce harmful medical overuse worldwide?

BMJ 2014; 349 doi: (Published 03 July 2014) Cite this as: BMJ 2014;349:g4289

Re: Can doctors reduce harmful medical overuse worldwide?

Italy’s campaign “Doing more does not mean doing better” is a bottom - up project as it was launched by Italy’s Slow Medicine, a movement of physicians, other health professionals, patients and citizens aimed at the promotion of a measured, respectful and equitable care.

Nine lists have already been published and a lot of other societies of physicians and nurses are joining the project, as well as hospitals: they appreciate that the main goal of the project is protecting patients’ interests through a partnership between health professionals and patients and users, and not “rationing” healthcare for cost cutting purposes.

Implementation of the project will require informing and training physicians and other health professionals as well as facilitating dialogue among the various health professionals and particularly between general practitioners and medical specialists.

Organizational changes will be necessary too - for example, radiologists should become more involved in decisions about imaging, which is often inappropriate.

There will be many challenges, of course.

The first is that many physicians claim they prescribe unnecessary tests and treatments as they are concerned about malpractice issues (defensive medicine). We will have to show them that shared decision making is more effective in protecting them from complaints and litigation.

Then, the fact that financial rewards for hospitals, even for public ones, are more focused on quantitative results than on qualitative ones hinders the contrast to appropriateness and waste.

Also, as the common message from the media to Italian citizens is that doing more is always better, different communication is needed to the general public, starting from the institutional level and dealing with the issues of overtesting, overdiagnosis and overtreatment.

Competing interests: No competing interests

10 July 2014
Sandra Vernero
Gianfranco Domenighetti - Antonio Bonaldi
Italy's Slow Medicine
Via Silvio Pellico, 24 - Torino - Italy