A campaign to combat "over-treatment" of patients has been announced by doctors' leaders this week. Called "Choosing Wisely", the initiative promotes more open conversations between doctors and patients, rather than an obsessive - and frequently financially incentivised - adherence to targets and guidelines. Consultant cardiologist Dr Aseem Malhotra authored the report, which was published this week in the British Medical Journal...
United States


00:00:00attempting to combat over treatment of NHS patience has been announced by doctors leaders this week old choosing wisely the initiative which has its roots in the US and Canada promotes more conversations between doctors and patients rather than an obsessive and freak me financially incentivized adherence to targets and guidelines Consulting cardiologists to see Malhotra off of the report which was published this week in the British medical journal well this is really Chris a initiative to win back the harms of tube too much medicine by don't sing at choosing wisely Campaign which Mission we started in the United States a couple of years ago and this is really to help encourage a more informed and shared decision-making process between doctors and patients around treatments and investigations because we believe there is a major problem around over treatment and overdiagnosis what's the evidence for that
00:00:59dates but I'll come on to the UK in a second and sent me I believe this is a global problem and the United States has been estimated that one third of all Healthcare activity brings no benefit to the patient we talked about healthcare system which is spending close to 4 trillion dollars a year which is quite staggering of the u.s. system works the u.s. is gout lead least efficient Health Care Service in terms of money spent per person treated per year of any health care provider in the world it's an insurance that system and when people come in through the door for medical center there is an MRI scan of sitting there and if you put a patient through it you can charge them for an MRI regardless of whatever you need to do so it's in the interests of the healthcare provider ticket as many tests under their belt for somebody as possible to keep the money flowing now that's not the same in Britain that visit Chris York City right now. In my view is ethically GPS because actually what we're towards his doctors it's a treat patients on clinical need not
00:01:59the best medical practice no. Yes will give you this CT scan because we might pick something up I think there's a point to be made here is it when we practice medicine we should do on the best available independent evidence and if you'll go in the game stats and that's when the problem arises where people get diagnosed with conditions all going to cause any problems and I'm getting treated with medication to all going to benefit them in the cold side effects of great cost to the health system actually more important call me patience and the first thing we go to medicine is first Do no harm you mentioned in the United States insurance pay system and they have you know that basically rewarded as you say by great to volume not answering quality election UK we have some go pay with my results but actually in reality that is payment by activity and I'll talk to the same level as United States but it's very similar type of processing was very interesting is the quality outcomes framework which is a system that was set up around 10 years ago to try and incentivize GPS to treat patients on
00:02:59different Marcos of a risk for my health such as high blood pressure glucose control Etc a recent analysis is shown that for several Mark is an overall actually incentivizing GP than paying them to be not be very aggressively in terms of control blood pressure low glucose or other things class for for example has not benefited population Health intern the premature mortality and morbidity that's quite extraordinary and and one of the reasons for that as well is that a lot of the information out a lot of the published literature and the way that is reported actually grossly exaggerated benefit of any treatments and we know that clean up in clinical trials side effects of all so grossly under reported that's not to say that there was in a roll from what medicine of course um is there so many good things we do in medicine to sit and said he would have cute treatments this is about actually whining about the home from the excesses the ultimately will help patients now the way through this is actually having an informal discussion with patients and you know for example
00:03:59if somebody was too I'll give you one example you know I'm an Interventional cardiologist by training which means I perform a procedure through Keyhole to unblock people calling me all trees when they have narrowing seen them we know that people having an acute heart attack this is a life-saving procedure but if you have stable Korea launches East putting a stent in does not prevent a heart attack or prolong your life so they did an interesting study in America why they actually in one situation they would not tell them that stenting instable disease would would prevent a heart attack or or death in about 69% of patients elected to go through the procedure when they were told to ask you babe information only 46% elected to go for that procedure they calculated that if this conversation took place and it was making pulse real mandatory it would actually save 864 million dollars a year in US Health Care just from this specific procedure so this is a tip of the iceberg but actually what it's about ultimately Chris is greater transparency that's what we needed Medicine of Greater transparency
00:04:59greater accountability we get better Quality Healthcare cardiologist Aseem Malhotra urging us to Choose Wisely

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