Scotland's chief medical officer calls for over-treatment debate

Scotland needs to move towards a culture of 'realistic medicine' with GPs urged not to over-treat patients, the country's chief medical officer has said.

Scotland's chief medical officer Dr Catherine Calderwood has called for efforts to tackle over-treatment of patients. Picture: Andrew Matthews/PA Wire

In a wide-ranging report on the health of the nation, Dr Catherine Calderwood urged medics to move away from a ‘doctor knows best’ culture and discuss treatments more with their patients in order to reduce waste and cope better with the rising number of people with multiple conditions.

Doctors leaders welcomed the report but warned that it was a challenge for doctors to find time to innovate as morale was low due to rising workloads and high vacancy numbers.

Dr Calderwood, a consultant obstetrician and gynaecologist, cited increases in available medicines and a rise in expectations from the public as factors leading to over-treatment.

She said: “In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.

“This is especially true when a person has multiple conditions, each of which has its own list of recommended medicines and treatments.

“Realistic medicine is about moving away from the ‘doctor knows best’ culture. It’s about more fully involving patients in the decisions about their care. Of course this will only happen if people are prepared to have these conversations in this way with their doctors.”

Doctors tend to choose fewer treatments for themselves than they offer to their patients, Dr Calderwood said in her inaugural report after taking on the top position from Sir Harry Burns last year.

She added: “A person may achieve a greater quality of their life if less is done - fewer treatments, more targeted medication.”

The report also summarised data on Scotland’s health, highlighting inequalities in areas such as obesity, cancer mortality and smoking rates.

Dr Calderwood asked doctors to question variation in practice and outcomes, to reduce waste and encourages innovative ideas and research to improve medicine for the future.

Professor Derek Bell, President of the Royal College of Physicians of Edinburgh, welcomed the emphasis on lifestyle change rather than excessive prescribing.

He said: “We are supportive of the direction of travel of Dr Calderwood’s report and welcome the exploration of the challenges in ‘Realistic Medicine’. We particularly endorse the proposals to avoid overtreatment and excessive prescribing, while increasing attempts to support individual and population lifestyle changes.

“The College is committed to playing its part in contributing to these lifestyle changes through its ‘Health and Wellbeing’ work stream, which is promoting issues such as increasing physical activity, reducing alcohol consumption and tobacco use, and preventing obesity.”

Dr Peter Bennie, Chair of British Medical Association (BMA) Scottish Council, said: “Doctors are at the frontline in responding to the increasing demands of an ageing population at a time when resources are constrained and there are growing vacancies in consultant, GP, trainee and specialty doctor posts.

“It is good to see Dr Calderwood acknowledge the critical role doctors must play in shaping how medicine is practised in the future and how healthcare is delivered, to secure high quality patient care and the overall health of our nation.

“But whilst doctors can play a vital part in supporting the development of new approaches to healthcare models we must recognise that morale amongst Scotland’s doctors is very low with workload intensity continuing to rise, and that this is likely to have an effect on how well doctors can respond to the needs of a changing health care service and growing patient demand.

“Doctors want and expect to be innovators and leaders in improving outcomes for patients. To do this well, they need time in their busy working lives to learn, teach and reflect.”

Tackling health inequalities and improving healthy behaviour will play a key role in improving the health of the nation, he added.