Health news

GPs told that less is more

BMJ Group News

What do we know already?

Studies show that doctors don't always follow guidelines or do what research suggests is best for their patients, both in terms of providing safe and effective care, and minimising costs. There are lots of reasons for this, including pressure from patients for tests and treatments that might not be necessary, and a lack of up-to-date knowledge among doctors about the latest research findings - understandable, given GPs' heavy workloads and the steady flow of studies published every day.

To help doctors improve their care they provide, the National Physicians Alliance in the US asked a panel of 15 doctors for their top recommendations on improving patient care.

What are the recommendations?

Many of the recommendations address treatments and tests that are commonly provided, despite not being helpful, or even being potentially harmful.

Adults

Back pain: doctors should avoid doing MRIs and other types of imaging soon after the start of symptoms, unless there are signs of a more serious problem. Back pain usually goes away on its own in a few weeks.

Sinusitis: antibiotics shouldn’t typically be prescribed for sinusitis unless the symptoms last more than a week or worsen after first improving. Most cases of sinusitis are caused by viruses, which aren't killed by antibiotics.

High cholesterol: all statin drugs work well to lower cholesterol, so people should first be offered a low-cost, unbranded statin, before other drugs are considered.

Children

Sore throats: doctors shouldn’t prescribe antibiotics unless the child tests positive for bacteria called streptococcus. Most sore throats are caused by viruses, which won't be killed by antibiotics.

Glue ear: children don’t need to see a specialist early on, unless there are signs of other problems. Most cases of glue ear get better within a few months without any treatment.

Coughs and colds: parents shouldn’t give their children over-the-counter cough and cold medicines, as there's little evidence that they help, and they can cause side effects, which may be serious.

Asthma: doctors should recommend steroid inhalers to help children control their asthma and prevent attacks. Studies show these inhalers are safe and effective.

How reliable are the recommendations?

These recommendations should be quite reliable, as they are based on good-quality research. However, this is just one group's suggestions for improving patient care. A group of UK GPs might come up with a different list of priorities, although they would probably agree with most of the advice above.

Where do these recommendations come from?

The recommendations were published in the Archives of Internal Medicine, a journal owned by the American Medical Association. The project was funded by the American Board of Internal Medicine Foundation.

What does this mean for me?

Although the recommendations come from the US, they reflect principles that are encouraged among UK doctors. For example, UK guidelines also recommend avoiding the overuse of antibiotics.

What should I do now?

Some of these recommendations may surprise you, such as not giving children cough and cold medicines. Sometimes common health practices get out of sync with what science tells us is best. It's important for doctors to explain why they recommend (or don't recommend) a treatment or test - and for patients to ask questions if this isn't clear.