Health Support

Investigations – Choosing Wisely

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How many tests are done annually?

From the Royal College of Pathologists
Did you Know?
Hospital labs typically run over 1 billion tests per year at a cost of £2.2 billion.

  • 500 million biochemistry and 130 million haematology tests are carried out per year.
  • 14 tests for each person in England and Wales are performed annually.
  • 300,000 tests are performed every working day.
  • 50 million reports are sent from labs to GPs every year.”
    “Pathology facts and figures.” The Royal College of Pathologists website. Retrieved 7th March 2023.
    Pathology Facts and Figures

Many of these tests have real value in ensuring the best quality care for patients but not all and this has potential costs for patients and the NHS.

Reducing unnecessary tests which offer absolutely no value to any patient (in fact often wasting their time) would save the NHS enough money to employ an extra 6000 nurses (assuming a 10% reduction in the total cost).

Choosing wisely

As the Academy of Medical Royal Colleges suggest
“Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.

The aim is to help patients and their clinicians choose care that is:

Support for making better choices

How better choices can be made is explained below:

SHARED DECISION MAKING AND AN EVIDENCE BASED APPROACH

Choosing wisely (UK) refer to “Shared decision making” as the process which promotes the most effective conversations between patients and clinicians defining it as:
 “A collaborative process in which doctors and healthcare professionals work together with patients to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values. It explicitly acknowledges the fact that there is usually more than one way to treat a problem, including ‘no treatment’ and patients may require help to weigh up the benefits and risks of the options in order to determine the best choice for them. There is good evidence that shared decision making benefits patients, improving the quality and appropriateness of clinical decision making.”
“Shared decision making.” Choose Wisely UK website. Retrieved 7th March 2023.

The focus of Choosing Wisely UK is about shared decision making, using BRAN to encourage patients to get the best from conversations with their healthcare professional by asking four questions for any investigation or treatment.

  1. What are the Benefits?
  2. What are the Risks?
  3. What are the Alternatives?
  4. What if I do Nothing?

From Choosing Wisely UK
Downloadable patient leaflet
“More doesn’t always mean better: Helping you and your doctor make the right decisions about your careChoosing Wisely UK – Choosing Wisely UK

More information on shared decision making

There is much more information on shared decision making and how it can benefit your care under

Some simple examples of evidence based care

Importantly these examples are just for information and should only be used in a discussion with a clinician and are not a substitute for medical advice or treatment. In addition, as explained in the articles sometimes these tests are required, so the support of a clinician is helpful.

From NICE
There are many examples, but these are just four to illustrate when a test might not be needed:

What is important from these examples from NICE is not whether you have a test but that you work together with your clinician “to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values.” Links to NICE guidance throughout this web site often provides information on when and what tests should be done.

more detailed examples of evidence based care

From the Academy of Medical Royal Colleges
Their page on evidence-based interventions includes a number of examples of when tests and treatments may offer little value. Home – EBI

From Choosing Wisely Australia
Choosing wisely is an international initiative, including Australia. There may be some variation of evidence based care across countries so you should not rely on any recommendation but first discuss any choice with your clinician.
Though these are intended for clinicians many recommendations will be similar in the UK as for example, some of the recommendations from the Australasian Society for Infectious Diseases.
Recommendations Recommendations – Choosing wisely

False positive tests

This refers to the situation where a blood test wrongly indicates a potential abnormality. This is not common but explains why clinicians and patients together should always justify each blood test been done. When a test shows a potentially significant abnormality it will need to be repeated, wasting patient’s time and potentially causing some unnecessary anxiety, if there was no real value in doing the blood test in the first place.

An example of a false positive can occur with a raised potassium:

From the Mayo Clinic
High potassium (hyperkalaemia) High potassium (hyperkalemia) Causes – Mayo Clinic

Further information on investigations

General Information

Information on common investigations, undertaken by your practice, are included under

BOOKING AN INVESTIGATION OUTSIDE YOUR PRACTICE

Local guidance on how to book an investigation outside your practice, such as a blood test, X-ray, or other test can be found under

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