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Choosing Wisely in the UK: reducing the harms of too much medicine
  1. A Malhotra1,
  2. D Maughan2,
  3. J Ansell3,
  4. R Lehman4,
  5. A Henderson5,
  6. M Gray6,
  7. T Stephenson7,
  8. S Bailey8
  1. 1Consultant clinical associate, Academy of Medical Royal Colleges, London, UK
  2. 2Royal College of Psychiatrists sustainability fellow, Centre For Sustainable Healthcare, Oxford, UK
  3. 3Advanced trainee in general surgery, Welsh Institute for Minimal Access Therapy, Cardiff Medicentre, Cardiff, UK
  4. 4Senior research fellow, Department of Primary Health Care, University Of Oxford, Oxford, UK
  5. 5Chief executive, Academy of Medical Royal Colleges, London, UK
  6. 6Director, Better Value Healthcare, Oxford, UK
  7. 7Former chair, Academy of Medical Royal Colleges, London, UK and Institute of Child Health, London, UK
  8. 8Chair, Academy of Medical Royal Colleges, London, UK
  1. Correspondence to : A Malhotra; Aseem_malhotra{at}

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The idea that some medical procedures are unnecessary and can do more harm than good is as old as medicine itself. In Mesopotamia 38 centuries ago, Hammurabi pro-claimed a law threatening overzealous surgeons with the loss of a hand or an eye. In 1915, at the height of a surgical vogue for prophylactic appendicectomy, Ernest Codman offended his Boston colleagues with a cartoon (figure) mocking their indifference to outcomes and asking, “I wonder if clinical truth is incompatible with medical science? Could my clinical professors make a living without humbug?”

Diagnosis drives treatment, and in recent years the term overdiagnosis has been used to describe various situations where diagnoses lead to unnecessary treatment, wasting resources while increasing patient anxiety. Overdiagnosis can be said to occur when “individuals are diagnosed with conditions that will never cause symptoms or death” often as a “consequence of the enthusiasm of early diagnosis.” Overtreatment includes treatment of these overdiagnosed conditions. It also encompasses treatment that has minimal evidence of benefit or is excessive (in complexity, duration, or cost) relative to alternative accepted standards. A recent report by the Academy of Medical Royal Colleges argued that doctors have an ethical responsibility to reduce this wasted use of clinical resource because, in a healthcare system with finite resources, one doctor's waste is another patient's delay.A culture of “more is better,” where the onus is on doctors to “do something” at each consultation has bred unbalanced decision making.

Choosing Wisely in the NHS

Even before the inception of the NHS, the British tradition has generally been one of late adoption and cautious use of new medicines, procedures, and technologies. Nevertheless, the UK shows similar patterns of variation in use of medical and surgical interventions to those in the US, though less extreme in absolute terms. The National Institute for Health and Care …

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  • Aseem Malhotra and colleagues explain how and why the Academy of Medical Royal Colleges is bringing to the UK a US initiative to get doctors to stop using interventions with no benefit.