Choosing wisely in the UK: the Academy of Medical Royal Colleges' initiative to reduce the harms of too much medicine

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

Hammurabi, the sixth Amorite king of Babylon, 'proclaimed a law threatening overzealous surgeons with the loss of a hand or an eye'.

Main

Malhotra A, Maughan D et al. BMJ 2015; 350: h2308. 10.1136/bmj.h2308

'...overdiagnosis...lead(s) to unnecessary treatment, wasting resources while increasing patient anxiety.' So on one hand effete practices have to be abandoned, yet new ones have to be adopted. This paper introduces Choosing Wisely^®, a forum for the sharing of information between clinicians and patients (www.choosingwisely.org – for a dental example see 'Don't remove mercury-containing dental amalgams'). This has been developed in the US and Canada with the aim of ensuring treatments are both necessary, and free from harm. Colleges and specialist societies are invited to draw up lists of tests or procedures that are commonly used but whose outcomes are questioned; those most cited interventions should be discontinued. The causes of such overtreatment is a culture of 'more is better', the onus on the practitioner to do something and the link between pay and performance. However, this blunt approach offered by the Choosing Wisely^® initiative, must be shaped by the values held by patients.