medicine

40 Treatments You Don’t Need

Or, more accurately, 40 treatments which the medical profession think are a waste of time and should not be carried out in normal circumstances. The Academy of Medical Royal Colleges has today published a list of 40 procedures or treatments which they believe should no longer be considered routine and in most cases are unnecessary. The list is part of the “Choosing Wisely” campaign, aimed at ensuring that patients are well informed about medical treatment and are not over medicated. Worryingly 80% of doctors interviewed apparently admitted knowingly prescribing unnecessary drugs or treatment due to patient pressure.

The objective is to be welcomed. Assuming that this is not merely a cost cutting exercise, set against the background of the Secretary of State for Health announcing that there are 12,000 or more unnecessary deaths in the NHS every year, many of which are due to and not in spite of treatment, a reduction in medical interventions may well be advisable. Indeed, a report in Scotland last year indicated that 5% of hospital admissions north of the border were directly due to misprescription of drugs by GPs and not any other cause.

So is there any need for concern in the face of a common sense approach to reducing medical intervention? Some of the treatments or procedures listed are very familiar and commonly implemented.

The use of prostate specific antigen (PSA) screening for prostate cancer will, it seems, be phased out under these proposals. It has long been recognised that a high reading may be a false alarm and cause unnecessary distress to patients who do not have cancer and need no treatment. Equally a low reading may be falsely reassuring. Having said that, many men have been referred for further investigation following a high PSA test result and been diagnosed with prostate cancer at a point in time when the prospects for a successful outcome remain good. Is this screening programme really any more or less effective than any other cancer screening programmes?

Equally there have long been questions about the efficacy of monitoring a baby’s heart beat during labour. Yet in those cases where babies suffer a severe hypoxic event during delivery (oxygen deprivation leading to brain damage), the distress evident in the trace of the baby’s heart rate is often the first evidence of something going wrong.

If these and other treatments and interventions are to no longer be considered acceptable, let alone routine, does this change the landscape for potential clinical negligence claims? A significant feature of the test as to whether treatment is negligent is whether a “responsible body of medical opinion” consider it acceptable. It might well be difficult to identify a responsible body of medical opinion who, under current practice, would consider it acceptable to deliver a baby without monitoring it’s heart during labour. If such monitoring is not merely considered unnecessary but is actively discouraged, are we about to see a range of failings in medical treatment which were once unacceptable become defensible and the tragic outcomes of such failings become uncompensated?

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