40 Medical Treatments You Do Not Need
From unnecessary X-rays to misguided blood tests, a campaign has been launched to cut down on procedures that health experts say won't aid or improve your health or lead to a speedier recovery from illness. The Choosing Wisely UK website (www.choosewisely.uk.co) aims to cut down on over-medicalization and give pointers to doctors and patients on how best to treat health-related issues.
The academy says there is evidence that patients often pressure doctors into prescribing or carrying out unnecessary treatments and the NHS is also coming under increasing pressure to reduce over-medicalization - in other words the medicines and treatments it prescribes.
For some time now, GPs have been advised to cut back on prescribing antibiotics to patients.
The academy says patients should always ask five key questions when seeking treatment.
- Do I really need this test, treatment or procedure?
- What are the risks or downsides?
- What are the possible side-effects?
- Are there simpler, safer options?
- What will happen if I do nothing?
Prof Dame Sue Bailey, chairwoman of the Academy of Medical Royal Colleges, told the BBC: "Some of these treatments can be quite invasive, time-consuming; there are simpler and as-safe options, so why wouldn't you?
"Because I think what we've got is a culture of 'we can do something, therefore we should do something' and we need to stop and reflect and decide what is the best option for the patient in their individual circumstances."
Here is a list of several dozens of treatments deemed by senior medics from the Academy of Medical Royal Colleges (AMRC) to be of little or no use:
Having fluids administered directly into a vein while under the influence of alcohol will not make you feel better any more quickly.
If you have back pain and there are no other concerning features (such as compression of the nerve roots) you are unlikely to need investigations such as X-rays.
You should only receive a blood transfusion if it is really necessary, such as for major bleeding or severe anemia, and not if alternatives are available such as iron treatment if you have iron deficiency anemia. As an adult, you should only receive one unit of blood at a time unless you are bleeding heavily.
Broken bones (feet)
Small fractures of the base of the fifth metatarsal, a bone on the outside of the foot, do not usually need to be put into a plaster cast as they will heal just as quickly in a removable boot.
Calcium testing is used when there are symptoms of kidney stones, bone disease or nerve related disorders. It is not necessary to have a test if you have had one within the last three months unless you undergo major surgery or become seriously unwell.
Children (Broken bones -wrists)
Small fractures on one side of the wrist, commonly known as ‘buckle fractures’, do not normally need a plaster cast. They can usually be treated and get better just as quickly with a removable splint accompanied with written information for care. There is also usually no need for follow up in a fracture clinic.
Children (bronchiolitis, breathing problems)
In most cases, bronchiolitis, which is an inflammation of the small breathing tubes in the lung, gets better without treatment. Although seeing your child with breathing difficulties can be distressing, acute bronchiolitis should not be treated with medications called bronchodilators, which cause a widening of the small breathing tubes in the lung, as they have been shown to have little or no effect.
For children with chronic constipation, changes to diet and lifestyle should be considered first to relieve the symptoms. If this is ineffective Polyethylene Glycol, sometimes sold under the brand name MiraLax should be considered rather than lactulose, sometimes sold under the brand name Lactugal®.
Children (seizures, epilepsy)
If your child is having a prolonged seizure, giving medications (such as Midazolam and Lorazepam) which can be dissolved in the mouth are preferred to medications which are injected or administered by means of a suppository.
Children (flat head syndrome)
Helmet therapy is not effective in the treatment of plagiocephaly, which is also known as flat head syndrome, other treatment options should be considered and discussed with your doctor or specialist nurse, such as adjusting your child’s sleep patterns, ‘tummy time’ and physiotherapy.
Cuts and grazes
Studies have shown that drinking quality tap water is just as effective for cleaning and washing cuts and grazes as sterile saline solution.
Routine screening programs do not exist for dementia. If you think that you or someone you care for are displaying symptoms you should speak to your doctor.
Minor Head injury
Minor head injuries do not normally require imaging.
High blood pressure
You should only be considered for medication to treat high blood pressure, to prevent heart disease and stroke, if you have other risk factors and blood pressure readings consistently above 140-159/90-99.
High cholesterol (statins)
If you are taking a statin, which are often prescribed to lower levels of low-density lipoprotein (also known as ‘bad cholesterol’) at the recommended dose, you do not need to have your cholesterol levels routinely checked unless you have had pre-existing conditions such as a heart attack, stroke or a family tendency towards problems with high lipids.
Some injuries, such as hip and shoulder dislocations, can be treated under medications which make you feel a little drowsy (sedation) rather than put you to sleep (general anesthetic). This means you may not have to go to the operating theatre and can be treated in the ER.
If you are over 45, you do not usually need blood tests to diagnose the menopause. Typical symptoms include hot flushes and sweats and your periods may be much lighter or irregular in nature.
If you have experienced unexplained or recurrent miscarriages, medicines like aspirin, heparin or progesterone should not be used to reduce the risk of further miscarriages.
Ovarian conditions (cysts)
If you have a simple ovarian cyst of less than 5cm in diameter, and have not undergone menopause, you are unlikely to need a follow up appointment or have levels of a protein called Ca-125 checked.
Pregnancy (blood clots)
If you are pregnant, aspirin is not recommended as a way of reducing the chances of developing blood clots (thromboprophylaxis).
Pregnancy (big babies)
Unless you have diabetes or develop gestational diabetes during pregnancy, ultrasound scans should not be used to check if your baby is bigger than normal for its gestational age (macrosomia).
Electronic monitoring of your baby’s heart is only needed during labor if you have a higher than normal risk of complications.
Pregnancy (sodium valproate)
If you are planning a pregnancy or may be pregnant, you should not be prescribed sodium valproate for the treatment of epilepsy, migraine or bipolar disorder unless other medications are not working. If sodium valproate is prescribed, this should only be done after a full discussion of the risks and benefits to you and your unborn child.
Prostate conditions (PSA testing)
Unless you are at risk of prostate cancer because of race or family history, screening for a specific protein produced by the prostate (Prostate Specific Antigen-PSA) does not lead to a longer life.
Scans of the head (CT or MRI) can only be used to help diagnose psychosis in specific situations and are not necessary or useful in every case.
Surgery (Preparing for Surgery)
You do not need to come into hospital the day before surgery, if you have had the appropriate preparation, tests and discussions with your doctor beforehand. Usually you will not need routine tests before surgeries that are minor or intermediate in nature. National guidelines on testing before an operation should indicate when tests are necessary.
Most vaginal discharge is completely normal and does not require being seen by a healthcare professional. However, if you are experiencing frequent episodes of vaginal thrush you should have the skin around your vagina examined by a doctor or specialist nurse. They should rule out other conditions such as an allergy or low hormones (vaginal estrogen), rather than start another course of treatment for thrush.
When discussing treatment for adult schizophrenia with your doctor or specialist nurse, you or your advocate should consider whether medications taken by mouth or longer-acting medications given by injection would be better for you.
There is no one way to come to terms with a life-threatening illness. Decisions about your care must always suit your own personal beliefs and circumstances. Terminal cancer will often involve difficult decisions about your quality of life versus longevity. The decision as to what treatment is best for you will always be yours, and it is important that you discuss it fully with your loved ones, doctors and specialist nurses. Patients with cancer that cannot be cured are frequently treated with palliative chemotherapy. This is sometimes used to shrink the cancer or to eliminate distressing symptoms. A patient’s individual response to these powerful drugs depends on the nature of their tumor. As more and more different types of chemotherapy are used, a meaningful response becomes less and less likely. Furthermore, if one type of chemotherapy has failed altogether, then it is unlikely a different type of chemotherapy will work either. Chemotherapy is by its very nature toxic. Therefore the combination of failing to achieve a response and causing toxicity can ‘do more harm than good’. Finally, the use of chemotherapy with a low chance of a meaningful response can raise false hopes. If you have advanced cancer, the use of chemotherapy where the benefit is likely to be small and the harm may be great should be carefully considered. Similarly, if you are receiving palliative chemotherapy or radiotherapy, post-treatment CT scans or Magnetic Resonance Imaging (MRI) are unlikely to be of benefit to you or influence the decisions of the team looking after you. What really matters is how you feel and whether your symptoms improve after the treatment.
If you have a coil (intrauterine device, IUD) fitted to prevent pregnancy, you should be taught to check its placement by feeling the threads inside the vagina. This should be done regularly in the first month after it has been fitted and then after each of your periods or at regular intervals. You only need to seek professional advice when you cannot feel the threads.
The number of antidepressants given to patients doubled between 2005 and 2015. If your depression is being treated with antidepressants as prescribed by your doctor and you do not feel that these are effective, your medication should be changed or another medication added, which will work in parallel with the initial drug that was prescribed.
End of Life (life support)
Sometimes, being maintained on life support will not result in a recovery that is meaningful to you. Similarly if you are caring for someone in this situation you should have a discussion with the patient (if that’s possible) as well as with specialist clinicians about the goals that can be achieved through further treatment.
End of Life (medicines)
If you are particularly frail or have been told you have less than a year to live you should try to decrease the number of medicines you take to only those used to control your symptoms.
Ovarian conditions (polycystic ovaries)
If your doctor suspects you may have polycystic ovaries, you should have a blood test to look for the typical hormone pattern before further investigations.
When discussing treatment for adult schizophrenia with your doctor or specialist nurse, you or your advocate should consider whether medications taken by mouth or longer-acting medications given by injection are most appropriate to you.
Surgery (Considering having surgery)
When you are considering having surgery, you should be informed of your options and be given the chance to discuss the potential benefits and the potential harm of having the procedure. Your age, type of surgery and medical conditions may place you at a higher risk of developing complications or even death. Where this is the case it should be identified and you should be supported in making the right decision for you.
Surgery (Having an operation)
If you are having a surgical procedure, day surgery should be considered as the default option and is suitable in many cases (except complex procedures). Day surgery allows for a quicker recovery with less disruption to you and your home life and also cuts the risk of hospital acquired infections.