Jaroorat Bhi Hai Kya? Rationalization of clinical practice

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The practice of medicine today relies a lot on diagnostic investigations as an aid to diagnosis and management. The fact that the medical profession was placed under the purview of the Consumer Protection Act, may certainly have contributed to this trend. But, practicing ‘defensive’ medicine by overinvestigating a patient may not help the patient as they could lead to false positive results. The number of tests may make the patients more anxious. They also add to the healthcare costs, which should be a matter of concern for a country like ours, where patients pay most of their medical expenses out of their own pockets. Prescribing too many and at times unnecessary tests overburdens the healthcare system translating into an inefficient healthcare system.

The Choosing Wisely campaign launched in 2012 was a step forward to avoid medical tests, treatments and procedures. The campaign aims “to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary (www.choosingwisely.org)”.

Non-maleficence (do no harm) and beneficence (do good) are the pillars of medical ethics. As clinicians, it is our duty to provide the safest, cheapest but quality drug to our patients and prescribe the right investigation to the right patient.

“Jaroorat Bhi Hai Kya” is a campaign of the Indian Medical Association (IMA) to promote rational use of drugs and/or rational ordering of investigations and hospitalizations. This will help avoid litigations.
Rational use of drugs assumes importance particularly in view of the widely prevalent problem of antibiotic resistance globally. Extensive and injudicious use of antibiotics has been a major factor driving this public health crisis. Be cautious about off-label use of drugs, procedures. This may be considered a trial and need approval of Ethics Committee.

Before you prescribe any drug or order investigations, ask yourself the following questions:
• Is it necessary?
• Will it benefit my patient?
• Is it safe?

Remember, Think before you Ink …Use Wisely and not widely.