New resource for patients and GPs to manage requests for inappropriate treatment | Wbactive

The Royal Australian College of General Practitioners (RACGP) today launched a new clinical resource for GPs to help patients who are requesting inappropriate tests or treatments that can cause harm.

The online resource, titled First Do No Harm: a guide to choice wisely in general practice, was launched at GP22, RACGP’s annual conference, following a targeted consultation process in September and October 2022.

First Do No Harm aims to help primary care physicians work with patients to make shared decisions about evidence-based healthcare. Importantly, it provides both GPs and patients with information on why inappropriate tests and treatments can bring little or no benefit, or even harm, as well as evidence-based alternatives that meet patient needs.

It provides GPs with QR codes linked to patient-related information, allowing them to discuss treatments with patients while accessing complementary resources and highlighting recommendations through a traffic light system.

It is designed as a “living” resource that will be updated with new topics and current guides. The first five topics are:

  • Imaging in adults with acute low back pain
  • Management of subclinical hypothyroidism
  • MTHFR genetic test
  • Vitamin C infusions
  • Vitamin D Test.

First Do No Harm builds on the previous work of the RACGP, including the GP curriculum and positions on the judicious use of testing and treatment and patient inquiries about clinically inappropriate testing, and the College’s guidelines for preventive activities in GPs (the Red Book) and the Choosing Wisely initiative.

Chair of the RACGP Expert Committee on Quality Care, Professor Mark Morgan, said the resource aims to facilitate shared decision-making and better communication between GPs and patients, with guidance for GPs and patients.

“First Do No Harm will help patients make informed and balanced decisions about their health, including information they should consider asking their GP,” said Prof Morgan, co-chair of the resource.

“It also provides a practical resource to help GPs navigate difficult conversations with patients. A focus is on handling patient requests for medical tests, treatments and procedures when the evidence suggests patients are better off without them.

“Almost every GP has seen a patient come in for a consultation with their own treatment plan, possibly after self-diagnosing and researching their own symptoms. Soliciting others’ perspectives on a condition or symptom is understandable, but doing so can lead patients to make false assumptions or ask about tests or treatments that are clinically inappropriate for them.

“This poses a challenge for GPs, who are trained experts in primary care and in coordinating patient care with evidence-based testing, treatment and intervention, and referrals to the most appropriate specialist or related healthcare provider.”

dr Michael Tam, co-chair of the resource and a practicing GP, said First Do No Harm facilitates shared decision-making, which can help patients understand the uncertainty that often exists in healthcare, as well as the risks and benefits of different treatments.

“One of the best ways to build trust and shared understanding is to empower patients to participate in shared decision-making and ensure they are fully informed about their decisions. First Do No Harm is not a guide to what not to do — it provides both GPs and patients with evidence-based alternatives to inappropriate testing and treatment,” he said.

“This will help GPs and patients develop the confidence and understanding that is central to good practice. Patients who use evidence-based decision-making aids have better knowledge of the options, more accurate expectations of potential benefits and harms, and feel more involved in decision-making.

“Better informed patients make different, often more conservative and less expensive treatment decisions. Because when patients are empowered with information and a better understanding of the likely benefits and risks of treatment, they make more informed decisions about what is right for them.”


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