Royal colleges issue list of 40 unnecessary interventions

As an Fy1 working in a London teaching hospital, I read this article discussing avoidable tests with great interest. On a daily basis, I see elderly patients receiving CT chest/Abdo/Pelvis as a first line for chronic, incidental complaints as well as multiple imaging modalities being ordered contemporaneously e.g. CT, MRI and PET. A culture thrives where patients have investigations not because they will change management or prognosticate but because "they can" and where academic interest is the primary motivation.

As this occurs, the Trust tells us they can no longer afford to provide polystyrene cups for staff. I wonder whether management is targeting the wrong behaviour.

Entering medicine later in life, I come from a background in veterinary medicine, where as a clinician I faced conflicting pressures to generate revenue whilst rationalising cost to my paying client. Whilst this often was a barrier to "patient" care, it did force me to justify my clinical actions and approach cases in a stepwise manner.

In these financially unstable times in the NHS, we have a responsibility to clinically and financially rationalise the investigations that we order. If the costs of tests were included on hospital systems this may go some way towards triggering this way of thinking.

Patient care must always be paramount but if we continue to investigate with such a scatter-gun approach then we will be implicated in contributing to the inevitable collapse of the NHS.

When approaching tests, the question should not be "why not" but "why".