25 November 2022


New resource for patients and GPs to help manage requests for inappropriate treatments

The Royal Australian College of General Practitioners (RACGP) has today launched a new clinical resource for GPs to assist with patients who request unsuitable tests or treatments which may cause harm.

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

First Do No Harm aims to help GPs work with patients to make shared decisions on evidence-based healthcare. Importantly, it provides both GPs and patients with information on why unsuitable tests and treatments provide little or no benefit or may even cause harm, as well as evidence-based alternatives to suit the patient’s needs.

It provides GPs with QR codes linking to patient-facing information, allowing them to talk through treatments with patients as they access complementary resources, highlighting recommendations through a traffic-light system.

It is designed to be a ‘living’ resource that will be updated with new topics and up-to-date guidance. The first five topics are:

●    Imaging in adults with acute low back pain

●    Management of subclinical hypothyroidism

●    MTHFR gene testing

●    Vitamin C infusions

●    Vitamin D testing.

First Do No Harm builds on the RACGP’s previous work, including the curriculum for GPs in training, and positions on judicious use of tests and treatments and patient requests for clinically inappropriate tests , as well as the College’s Guidelines for preventive activities in general practice (the Red Book) and the Choosing Wisely initiative.

RACGP Expert Committee for Quality Care Chair Professor Mark Morgan said the resource was aimed at facilitating shared decision-making and better communication between GPs and patients, with guidance for both GPs and patients.

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

“It also provides a practical resource to help GPs work through difficult conversations with patients. A focus is how to handle patient requests for medical tests, treatments and procedures where the evidence suggests that patients are better off without them.

“Almost every GP has experienced a patient arriving at a consultation with their own plan for treatment, potentially following self-diagnosis and having done their own research on symptoms. It’s understandable to seek out others’ perspectives on conditions or symptoms, but this can lead to patients developing incorrect assumptions or asking for tests or treatments that are not clinically appropriate for them.

“This creates a challenge for GPs, who are trained experts in primary care and in coordinating patient care with evidence-based tests, treatments and interventions and referrals to the most appropriate specialist or allied health professional.”

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

“One of the best ways to build trust and a shared understanding is by empowering patients to participate in shared decision-making and ensuring they are fully informed of their choices. First Do No Harm isn’t a guide of what not to do – it also provides both GPs and patients with evidence-based alternatives to inappropriate tests and treatments,” he said.

“This will help GPs and patients develop the trust and understanding that is central to good practice. Patients using evidence-based decision aids have improved knowledge of the options, more accurate expectations of possible benefits and harms, and feel that they had greater participation in decision making.

“Better-informed patients make different, often more conservative, less costly choices about treatment. Because when patients are empowered with information and better understand the likely benefits and risks of treatment, they make more considered choices about what is right for them.”


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