Doctors lack clear evidence on treatment benefits and harms

Doctors do not have enough easily understandable information about the benefits and harms of potential treatments, Aleksi Raudasoja, a general practitioner and editor at the Duodecim medical journal, told Yle.

As a result, patients may receive ineffective treatments or even treatments that cause harm, Raudasoja said on Yle’s morning programme.

“When that information is not available, making rational treatment decisions is often very difficult and can remain somewhat vague,” Raudasoja said.

Sara Launio, a chief medical officer at Finland’s Institute for Health and Welfare, said the lack of information could also lead to treatment being provided on insufficient grounds.

“The less strictly we apply the criteria for providing treatment, the more likely it is that the patient will receive no benefit but will suffer harm. It also becomes more expensive,” Launio said.

One in five treatments provides little benefit

Markus Haapanen, Finland’s first associate professor of implementation medicine, told Yle News on Sunday that as many as one in five healthcare procedures or other treatment practices provide patients with little health benefit.

He said, for example, that a shoulder operation already on Finland’s list of low-benefit treatments has not been shown to be more effective than placebo surgery at treating the problem.

Several countries have lists of treatments that provide little benefit. In Finland, the list is called “Choose Wisely”. Norway has taken a stricter approach by placing three common medical procedures on a list of treatments to avoid because their benefits are limited.

The procedures are certain shoulder operations, gastroscopy for people under 45 who have no warning symptoms, and contrast-enhanced imaging for chronic coronary artery disease.

Raudasoja said Norway’s approach was a positive development because it clearly identifies treatments that patients do not need and directs resources towards reducing their use.

Examples of low-benefit treatments commonly used in Finland include antibiotics for viral infections. In such cases, patients effectively receive only harm from the treatment, Raudasoja said. Antibiotics do not work against viruses and are used to treat bacterial infections.

Providing treatment can feel easier than withholding it

Psychological factors also influence treatment decisions, according to Raudasoja. Healthcare services treat many low-risk patients for whom a procedure provides very little health benefit.

“In these situations, it can often be easier for a doctor to offer a particular test or treatment, partly as a way of showing care,” Raudasoja said.

Raudasoja has written a doctoral dissertation on discontinuing the use of low-benefit treatments.

Launio said certain patterns of thinking also affected treatment decisions. People tend to think that active measures are better than passive ones, she said, adding that healthcare professionals should receive more training in weighing risks and benefits.