Prevention of low-value care: What's the role of the general practitioner?

Abstract

Prevention of low-value care: What's the role of the general practitioner? Abstract. Low-value care, defined as inappropriate care (potential harm exceeding the benefit) or overuse (unnecessary care), is a challenge for patients, healthcare providers, politicians and healthcare systems. We give some examples of low-value interventions in Switzerland. There are many triggers of low-value care. For example, new technology may lead to an earlier detection of disease but this is not necessarily translating into a benefit for the patient (overdiagnosis). Other reasons are organizational shortcomings, supply-driven demand, commercially motivated extension of disease definitions (disease mongering), and the impact of social or cultural beliefs. Correspondingly, it's not a simple task to tackle low-value care. As an answer, several concepts and campaigns have been developed during the last few years, such as Quaternary Prevention, Choosing Wisely or Preventing Overdiagnosis. Their aim is to protect individuals from medical interventions that are likely to cause more harm than benefit. What's the role of the general practitioner (GP) in the prevention of low-value care? First, to be aware of such inappropriate interventions and to be open-minded to question the own professional attitude. Second, as a trusted person by the patient, the GP has the unique opportunity to balance benefit and harm of an intervention together with the patient and to discuss these issues in a participative way (shared decision making), using techniques like team talk, option talk and decision talk. In summary, the protection of patients from inappropriate care, overuse and harm is an important part of our professional performance.