Re: Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine
It was my first on call as a surgical house officer. The second patient who had the benefit of my expertise (cough-cough) was a young adult with suspected appendicitis. I clerked and examined the patient, electing not to inflict a rectal examination. My logic was that the patient would be admitted and have an ultrasound, bloods etc irrespective of the findings of my index finger.
I presented the case to the registrar, who was shocked that I had not performed a rectal examination and ordered me back to the bedside. I sheepishly explained to the patient what I needed to do, who reluctantly agreed to it.
As I left the patient’s bedside, I couldn’t help but feel guilty that I had inflicted an unpleasant and entirely unnecessary examination (investigations and treatment were to remain identical irrespective of my rectal examination) just because “you should always do a PR”.
On reflection of this experience, I began to question the value of some investigations and treatments that we, as doctors, offer to patients. Why does every medical admission need a chest x-ray? Do we really need to do full blood counts so often on so many of our inpatients?
In a health system with finite resources, the over investigation and over treatment of patients is not just wasteful, it also detracts from the ability of the system to provide adequate care to the next patient. It can also, more directly, lead to negative health consequences. For example, there is serious concern that the over-use of antibiotics will lead to the development of ‘superbugs’ that we cannot treat (1).
The skill of a clinician is not in subjecting every patient to an inordinate amount of tests and occasionally making a diagnosis House would be proud of, it is about making balanced, appropriate decisions on when, who and what tests to investigate patients with.
I am both encouraged and hopefully that the adoption of the Choosing Wisely campaign in the UK will lead to improved efficiency in patient care, with a more considered approach to investigating and treating patients.
1. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014 Dec;5(6):229–41.
Competing interests: No competing interests