Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
By having discussions that are informed by the doctor, but take into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.
Across the UK, there is a growing culture of overuse of medical intervention, with variation in the use of certain treatments across the country. For example, the prescribing of antibiotics can vary by as much as two and a half times between one part of the country and another.
Common examples of overused medicines are antibiotics for common colds or other non-bacterial infections or prescriptions given for mild depression when alternative options such as exercise could be explored first.
The problem for patients is that all tests, procedures and interventions have side-effects and some may even cause harm. A CT scan is 200,000 more powerful than an airport scanner; a blood test for one patient may have very few side effects but for an elderly patient it may be distressing and painful.
Choosing Wisely was created in part to challenge the idea that more is better or in the case of medical intervention: just because we can, doesn’t always mean we should.
The Choosing Wisely principles encourage patients get the best from conversations with their doctors and nurses by asking four questions.
- What are the benefits?
- What are the risks ?
- What are the alternatives?
- What if I do nothing?
While it may have been true a generation or so ago, it is no longer always the case that the ‘doctor knows best.’ Medical advances have been so dramatic that there is now an armoury of tests, treatments and procedures available to patients. A doctor can only know which course of action is right for you after a discussion about your experiences of your illness; your social circumstances; your support needs; your preferences and attitudes to risk and what being well means to you.
This is what healthcare professionals refer to as ‘shared decision making’ which is also summed up by the phrased “no decision about me, without me.”
Why the Academy is leading this campaign?
Choosing Wisely UK brings together a range of patient and health related organisations from across the country and is hosted at the Academy of Medical Royal Colleges, the coordinating body for the UK and Ireland’s 24 medical royal colleges and faculties.
In 2016 the Academy asked all royal colleges and faculties to identify five treatments or procedures commonly used in their field, which are of questionable value and therefore the appropriateness of their use should be discussed carefully with patients before being carried out. Each was rigorously researched and cross-examined by some of the most eminent doctors in their specialty and then cross-referenced with National Institute for Health and Care Excellence, which provides doctors with guidance on treatments. NICE, as it is generally known, has been involved in the process every step of the way.
Choosing Wisely’s key aim is to change the culture when it comes to prescribing. We know this takes time, but we know it can work. In Italy, for example, Choosing Wisely is known as ‘slow medicine’ The Academy will continue to work with doctors to further develop the list of tests, treatments and procedures to support patients to get the most out of their care. This change in practice will only happen through collaborative working. If you have any feedback or would like to get more involved, please contact the Choosing Wisely team