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Chief medical officer urges doctors to prescribe fewer medicines

In her annual report, Dr Catherine Calderwood said overuse could cause 'hidden harm'.

Prescription:  Resources could be better spent elsewhere, report argues.
Prescription: Resources could be better spent elsewhere, report argues. Anthony Devlin / PA Wire/PA Images

Doctors should prescribe fewer medicines and do more to involve patients in treatment plans, according to Scotland's chief medical officer.

In her annual report, Dr Catherine Calderwood said overuse of prescription medication was a "serious concern" that impacted NHS budgets and could cause "hidden harm".

The report argued the resources spent on medicines could be better used to tackle poverty and improve education, housing and other environmental factors which may in themselves "produce significant benefits in both life experience and the incidence of diseases".

Dr Calderwood used the report to call for the profession to debate "realistic medicine", arguing fewer treatments may lead to a better quality of life for some.

She said doctors across the country are "doing a tremendous job" for patients but argued: "In striving to provide relief from disability, illness and death, modern medicine may have over-reached itself and is now causing hidden harm - or at best providing some care that is of lesser value."

Widespread use of guidelines has contributed to "the massively increasing volume of medication taken by the population each year", according to the report, with 20% of adults taking more than five medicines every day.

The relationship between doctors and patients has "evolved a system and culture which favours 'doctor knows best' or medical paternalism", where the balance of power has shifted heavily on to clinicians to decide treatment in the best interests of the patient.

"Doctors often fail to take into consideration patient preferences in suggesting and providing treatment," the report said.

"Treatment that does not coincide with the patient's preferences may ultimately be wasteful (in that it doesn't provide value for them)."

GPs: Patients 'should be more involved' in treatment plans.
GPs: Patients 'should be more involved' in treatment plans. Andrew Matthews/PA Wire/PA Images

Patients tend to choose less treatment when they are given greater detail about the possible benefits and side-effects, while doctors "generally choose less treatment for themselves than they provide for their patients".

Dr Calderwood said: "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."

While she said this would "only happen if people are prepared to have these conversations in this way with their doctors", she added: "It's an interesting fact that doctors tend to choose fewer treatments for themselves than they offer to their patients.

"As doctors we should be asking why that is and whether patients - if better informed - might also choose less intensive and less medicated treatment regimes."

Prescription: Report says over use is a concern
Prescription: Report says over use is a concern Andrew Milligan / PA Wire/PA Images

Dr Peter Bennie, chairman of the British Medical Association's Scottish council, said: "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 healthcare service and growing patient demand."

Green health spokeswoman Alison Johnstone welcomed the report.

She said: "Improving the quality of life for patients ought to be at the heart of the health service and I'm pleased to see the chief medical officer highlight the importance of tailoring treatment decisions to fit the needs of each individual as well as to support people who want to adopt healthier habits.

"We absolutely need an NHS that can take care of illness when it occurs, but preventing ill health should be on the top of our priority list."

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