Intended for healthcare professionals

Rapid response to:

Opinion Taking Stock

Rammya Mathew: Helping patients off the conveyor belt of interventions

BMJ 2023 ; 381 doi: (Published 05 April 2023) Cite this as: BMJ 2023;381:p761

Rapid Response:

Re: Rammya Mathew: Helping patients off the conveyor belt of interventions

Dear Editor

Rammya Mathew’s powerful, and moving, description of the disruption caused by overuse of tests and reminders deserves much wider readership -- for example, by every specialist group seeking to add yet another nudge to clinical practice. The call by the Chief Medical Officers and other leaders in the first editorial of the 2020s -- responding to the challenge of multimorbidity -- has had little impact and it is up to GPs to practise Cluster Medicine for people like me, with four diagnoses and eight pills, who are not fortunate enough to be supported by Geriatric Medicine.

The General Practitioner needs time for empathy and time to focus in those precious minutes of the consultation without even more low value prompts for action. I was recently informed I had ‘pre-diabetes’, with a body mass index of 23, adding yet more time required for a doctor or nurse to explain what pre-diabetes is thought to be.

The people called patients also have a part to play. They need to be prompted to think more clearly before they arrive at the consultation -- for example, about what is actually bothering them most and about what questions they want to ask. They also need to be given reading and learning about, for example, HbA1C or how to manage anxiety about their conditions. This obviously requires a digital wellbeing service for better self care, and for digital groups to meet with others with the same problem who are there 24/7. Many people are not yet online but this is changing and everyone will have ‘the internet’ for a ‘mains’ knowledge service just as they have mains electricity and water.

Rammya Mathew’s analysis needs its own editorial linked back the CMO’s editorials on multi morbidity and on secondary prevention

Competing interests: We are developing a digital self care service

16 April 2023
Muir Gray
director of the Optimal Ageing Programme