Some medical treatments are pointless. But will patients want to know? | Fay Schopen

Imagine going to a doctor with a broken foot, say, or a bad back, or in a worst-case scenario, cancer, and being told that doing nothing would be the best course of action? Naught, zero, forget about it, go home – it hardly sounds like heartening advice.

But that could be the case. Senior doctors say that many procedures routinely carried out are in fact pointless. The Academy of Medical Royal Colleges, which represents 22 colleges, has published a list of 40 tests or treatments that they say have little to no effect on the patient, including x-rays for back pain and plaster casts for some small fractures.

The move is part of a campaign called Choosing Wisely, aimed at helping both medical professionals and patients to make informed decisions. A laudable goal of course, but as truth after sober truth unfurls on the website it feels like being repeatedly told that Father Christmas doesn’t exist. You know in your heart that this information is correct, but you don’t really want to hear it. Sure, you’ll come out the other side wiser and more mature, but also sadder; carrying with you the dull, adult ache of acceptance. The world is somehow a less joyful, more utilitarian place when you know that tap water is just as effective as cleaning cuts and grazes as sterile saline solution, or that hooking yourself up to a drip after an epic bender will not make you feel any better (although it does make for a great Instagram post).

Doing nothing when it comes to our health is not a palatable idea. We live in the age of intervention, when the most important thing in life is to do something, anything, everything – to have control over our own destiny. This way of thinking has spawned a million lifestyle bloggers, thousands of wellness apps, and more photographs of avocado on toast than could ever be necessary.

And there are some extremely serious – and uncomfortable – truths outlined by the academy. Palliative chemotherapy – sometimes used to shrink tumours or eliminate distressing symptoms – may not be the best course of action for terminal cancer patients, for example. Chemotherapy is toxic, and the academy says it may do more harm than good and can raise false hopes.

The truth is that many aspects of life are simply uncontrollable. Ageing, infertility, death and disease – even broken bones – are most often out of our hands. And hearing this news now, post-Brexit, when unemployment, housing and the economy are looking so precarious is an added kick in the teeth. When things are this bad, we want the illusion of control at least.

Who wants to tell a hopeful, expectant and possibly angry patient that ‘nothing’ is the answer?

I speak as someone who last week spent £70 on supplements in my local health food shop, in an almost certainly useless attempt to turn the clock back and coax my ovaries, ravaged by the chemotherapy I had five years ago, into spitting out one or two final, viable eggs. This was after being told by a consultant that I was extremely unlikely to be able to conceive. Did I accept the news stoically and quietly? Did I thank my lucky stars that at least I was alive, and feel grateful? Of course not. I whipped out my phone and began combing message boards and medical journals, downloading papers, buying books and noting down names of supplements I had never heard of. Doing nothing in the face of life’s black humour feels defeatist.

“You can’t put a price on health can you!” I said like a lunatic in the shop, embarrassed to be spending so much on what could be quite possibly be snake oil. Well, yes, you can: £70 in my case. It should also be noted that the consultant did not tell me to do nothing either. Despite the diminishing odds of IVF and my advancing age, there were “options”, she said. I didn’t ask what they were as I have a fair idea (donor eggs; surrogacy; Betty Blue-style madness) and I am not a millionaire. Infertility is a field ripe for doing something rather than nothing. A perfect convergence of the unbearable sadness of longing for a child, coupled with advances in technology and a faint ray of hope. It was a private clinic, and I felt like a walking wallet rather than a patient.

Choosing Wisely, however, addresses things that are more prosaic. It was launched in part to address the fact, revealed in a study carried out last year, that 83% of doctors said they had prescribed or carried out a treatment that they knew to be unnecessary. Well sure – they’re only human. Who wants to tell a hopeful, expectant and possibly angry patient that “nothing” is the answer?

Surely medical professionals have been merrily x-raying backs and putting feet in plaster casts and so on because on some level these things make patients feel good. Sometimes doing something, anything, is a placebo – and perhaps if this was recognised as such, the truth would be more palatable.

Some medical treatments are pointless. But will patients want to know? | Fay Schopen

The NHS does not want any much more pointless alter | Zara Aziz

‘The providers I locate helpful for patients such as on-web site district nursing are often the 1st to go.’ Photograph: Alamy

12 months on 12 months, if not month on month we are faced with alter, and it usually feels like adjust for change’s sake. Just as I get accustomed to the most current health policy, it is scrapped in favour of a new idea. The solutions that I locate useful for individuals, this kind of as community clinics or on-website district nursing, are frequently the 1st to go. Streamlining and efficiency are the buzzwords we hear, but they equate, invariably, to price cutting and dropping standards of care. Somewhere along the way, the patient expertise is all but lost. So fast is the pace of adjust that the only way to preserve abreast of all the reforms is to give up valuable clinical time, some thing that numerous of us have neither inclination nor capacity for.

In his speech to the NHS Confederation final week, the chief of NHS England, Sir Simon Stevens, emphasised the relevance of flexibility and the need to have regional models of care. His assistance for generalist local community clinics and hospitals is a welcome U -flip on prior policy. Previously, we have observed a move to encourage GP practices and smaller sized hospitals to restructure into greater organisations, while frowning on smaller sized, a lot more conventional family practices or cottage hospitals. But sufferers like personalised care. A single of my elderly patients was upset about how huge we had turn into (we have close to 15,000 individuals, although in 2010 it was about ten,000 patients). We have grown because there are couple of GP practices locally in an area of substantial patient population and demand.

Some adjust is inevitable and can be time-conserving and useful, to workers and sufferers alike. IT innovations suggest that I can often make on the web referrals to secondary care while the patient is even now in the area and give them paperwork for their referral. Yet other changes make no sense at all. When I first grew to become a GP, I referred individuals needing an admission to the on-call registrar for a particular specialty. It meant discussing the rationale for admitting a patient with a senior clinician, who would challenge you appropriately on your evaluation.

With a rise in demand and population, this model of referral was not sustainable, as the registrar would just be on the telephone all day taking referrals, and not treating sufferers. Bed managers, who are usually senior nurses, commenced taking referrals from GPs, and this worked to a degree. Much more just lately, this has transformed again so that every single referral regardless of specialty goes through a centralised telephone line, exactly where contact handlers operate via protocols (a bit like the NHS 111 service). Referrals have to be black and white. I am advised that my pregnant patient with pyelonephritis (kidney infection) does not “fit” the referral criteria, as she is pregnant and have to go to her maternity unit. When I contact the maternity unit, they come to feel it is a medical, not an obstetric, problem. Someplace in the middle, a heavily pregnant patient is left waiting.

NHS reforms have meant that hundreds of thousands have been spent on redundancy payouts to thousands of employees, yet 1 in 5 of people created redundant have been re-employed by the NHS in some kind. These administrative changes have been hugely expensive and demoralising to a workforce that currently has a recruitment crisis. We do not create sufficient doctors – it is as well costly to do so.

Anxiety and poor task satisfaction mean that several junior medical professionals emigrate or shy away from basic practice or emergency medication as specialties. Except if we cut the red tape, the exodus will carry on to the point of unsustainability.

Governments come and go, but each and every leaves its mark, with sweeping changes that are never gradual and frequently pointless. I know I am not alone in contemplating that the NHS need to be free of charge from political interference, from any party. Stevens says every permutation to restructure or radicalise has been considered of over the many years perhaps it is now time to listen to patients and staff and leave properly alone concerning the items that do function properly within the NHS.

The NHS does not want any much more pointless alter | Zara Aziz