25 October 2016 08:54:14

Do you really need that test?

The Academy of Medical Royal Colleges has just launched a new campaign - Choose Wisely UK. They've come up with no fewer than 40 tests and treatments that may not be necessary.

You know that medical test or treatment Dr Google told you needed? Here's a newsflash - Dr Google might be wrong. And what's more, not only could that test or treatment be useless, it could even do you harm.

The Academy of Medical Royal Colleges has just launched a new campaign - Choose Wisely UK. They've come up with no fewer than 40 tests and treatments that may not be necessary. All of us are aware these days that the NHS is short of money, and many of you might be worried that it's just more cost-cutting wrapped up as patient choice. But I've looked through the list - and I agree with every one.

There is one obvious target that isn't there - there's no mention of the fact that coughs and colds won't get better one second quicker if you take antibiotics. I'd like to think that's because the message has got through already - but that would be a triumph of optimism over experience in my consulting room.

But let's look at some of the others:

People who are in the last year of their life should discuss reducing or cutting out 'preventive' treatments. I remember my own mother's pile of blood pressure and cholesterol-lowering medications lined up on her table until I talked to her GP. She hadn't thought to question them, and gainfully choked them down even though the fungal infection in her throat made swallowing agonising. She died peacefully at home from cancer two weeks later. I can't blame the GP - she died just three weeks after she was diagnosed with cancer - but it has certainly changed the way I look at my patients' list.

If you're taking a statin at the recommended dose, you don't need to check cholesterol levels regularly. Doctors used to be advised they had to check liver function with a blood test once a year for patients on statins, so we'd tick the box for cholesterol out of habit. But if your statin was working to control your cholesterol last year, it'll be working just the same this year - and we now know there's no need to check liver function after the first year.

If you use a copper coil or a hormone-releasing Mirena® coil and have been taught to check the threads regularly to check it's in place, you don't need to see the GP until it needs changing. It's easy to learn how to do this, and you can be just as good at is as we are.

If you've had a pre-op assessment and have been cleared for surgery, you don't need to go into hospital the night before. You'll sleep much better at home and we can keep our precious hospital beds for sick people who need them.

Improving fitness, stopping smoking and reducing alcohol reduces the risk of complications after surgery - so obvious I won't even dignify this comment by expanding, although the fact that it's in the list is a stark reminder of how many people need to be reminded.

An ovarian cyst less than 5cm, found before the menopause, doesn't need following up. The concern has always been missing a cancer, but cysts this small with no worrying features aren't cancerous. Repeated scans, on the other hand, just lead to worry.

You don't need a blood test to diagnose the menopause if you're over 45. Women often want a test 'just in case' - but hot flushes and irregular periods are more than enough to make the diagnosis. Menopausal symptoms under 45 do need checking out, because of the risk of osteoporosis from premature menopause which would signal your doctor to discuss preventive treatment.

Doctors don't routinely need to do vaginal swabs for women with likely thrush or bacterial vaginosis. Your doctor has no more desire to do that examination than you have to be subjected to it - so it's a win-win to know that it's not needed.

X-rays for minor head injuries or non-specific low back pain with no concerning features like trauma, a history of cancer, leg weakness or changes to your bladder or bowel function aren't needed. They don't help you - they either won't find anything or they'll confirm that you have a 'touch of arthritis', which we knew anyway - and you won't be exposed to more radiation than necessary.

Tap water is just as safe as sterile saline for cleaning up cuts and grazes. And given that 'saline solution' = salt, you're not literally rubbing salt into the wound!

You might think this advice is all for doctors, but actually you can help yourself, too. The campaign suggests that before you have any test or treatment, you ask:

1. Do I really need this test, treatment or procedure?

2. What are the risks or downsides?

3. What are the possible side effects?

4. Are there simpler, safer options?

5. What will happen if I do nothing?

I spend a lot of time teaching my registrars (the GPs of tomorrow) to ask themselves, before they do any test 'Will it change my management?' They come to me fresh from hospital, where there's a bit of a culture of doing test 'just in case'. In our world, where an ambulance-chasing lawyer lurks round every corner, I really do understand that. But they - and you - and I - need to hold on to the fact that unnecessary investigations and treatments can do harm too. So from my perspective, the Choose Wisely campaign offers wise words indeed.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.