Rammya Mathew: Tackling overmedicalisation must become a political priority

Overmedicalisation has been around as a concept for more than 20 years, with campaigners ardently trying to shine a light on the harms of too much medicine.1 But you only have to speak to fellow colleagues to realise that it’s still very much a peripheral concept. Most doctors still take the view that over-intervention is an infinitely better option than under-intervention. But from the extent of overmedicalisation I see in general practice alone, I don’t believe that this is a helpful perspective.

Patients are consulting us more than ever before. The average person now consults their GP eight times a year, with frequent attenders consulting as many as 40 times.2 People seem to have become much less comfortable with the idea of self-management and are increasingly seeking reassurance for mild symptoms, sometimes after only a few days.3 The inherent problem is that, as soon as patients consult a healthcare professional, they’re more likely to receive some kind of intervention. This is partly due to a growing consumerist attitude towards healthcare but also because “medicine is permeated by a bias towards doing something.”4 This is reflected in examples of GP activity such as two week wait referrals, which have more than doubled over a 10 year period while conversion rates to cancer diagnosis have decreased.5

It’s also worth noting that it can be difficult to stop doing investigations for patients once we start. For example, if after blood tests we risk profile a patient as having a pre-disease state such as “pre-diabetes,” the patient will be having annual blood tests from then on. Likewise, incidental findings from initial investigations mean that we can end up committing patients to long term surveillance of pathology that they would otherwise never have known about.

And if our patients are unfortunate enough to have a chronic disease diagnosed, you can see their medication list progressively grow in size, often without the root cause of their illness ever being fully dealt with. Unsurprisingly, they end up experiencing side effects from the cocktail of drugs imposed on them, and this is managed by—you guessed it—more tests and more treatment. “Problematic polypharmacy” creates a vicious cycle of over-intervention that leads to serious harms, especially in our older patients.6 This is compounded by the use of single disease guidelines in managing patients with multimorbidity, which also encourages an unreasonable number of interventions78 and means older patients ferrying back and forth from endless hospital appointments.

The fight against overmedicalisation is a David and Goliath story. There’s no commercial interest in tackling it; nor is it advocated for by patients or charity groups.9 It’s left to small groups of professionals working relentlessly to keep it in the spotlight,10 by challenging us all to consider the risks and benefits of any intervention—and to continually question health policy that fails to acknowledge the far reaching consequences of overmedicalisation on individuals and on our capacity to deliver a sustainable healthcare system.1112

In the run-up to the next election we’ll see political parties coming forward with their rescue plans for the NHS, promising the moon on a stick in an attempt to win over the electorate. Politicians know that people feel the pain of the “8 am rush for a GP appointment,” but the impact of overmedicalisation is much less tangible, and tackling it will never be a vote winner.

This unfortunately leaves us on the hamster wheel of too much medicine, with people coming to harm from over-intervention and a health service that continues to bear the opportunity cost of decisions that put votes before people.