'Culture of fear' hampers GP treatment options, says GPC

GPs are too restricted by guidance to target overtreatment as they would like, the GPC has said following the launch of a campaign to limit medical interventions.

Dr Andrew Green: reform guidance (Photo: JH Lancy)

The Academy of Medical Royal Colleges (AMRC) has launched the Choosing Wisely initiative to get doctors to cut down on treating and testing patients.

It has asked each medical royal college to list its top five tests and interventions that are commonly used, whose ‘necessity should be questioned’. Doctors should discuss the risks and benefits of these treatments with patients, Dr Aseem Malhotra wrote in the BMJ.

But GP efforts would need to be accompanied by changes to guidance, GPC clinical and prescribing subcommittee chairman Dr Andrew Green told GPonline.

Fear of litigation

GPs ‘increasingly see the harms caused to patients by medical intervention’ and would support the campaign, Dr Green said.

‘However, for this initiative to really have impact the underlying causes of overtreatment and over-investigation need to be addressed, and these include fear of litigation, intolerance of uncertainty, worry about critical comments on NHS choices, and specialist-dominated guidance.

‘It is important that this debate focuses on what is right for the patient, and is not conflated with arguments about rationing as appears to have happened in some of today's lay press reports,’ he added.

Very real change

‘It is my hope that we are beginning to see a very real change in medicine towards more thoughtful practice with less intervention, but this report is only a small step on a journey that will require us all, patients, doctors, lawyers and regulators, to rethink our positions,’ Dr Green said.

The RCGP welcomed the campaign but said that GPs are ‘often under considerable pressure to prescribe’.

‘The RCGP will be supporting the Academy’s Choosing Wisely initiative, and has established its own working group on over-medicalisation to feed into discussion on the topic at the college’s governing council meeting,’ said college chairwoman Dr Maureen Baker.

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