A QUARTER of diagnostic tests carried out by the NHS in Scotland are "not appropriate or necessary", the country's chief medical officer has said as she called for a shift away from over-treatment.

Dr Catherine Calderwood said the ''doctor knows best" culture should give way to "shared decision-making and reducing harmful and wasteful care". This included having "honest conversations" with terminally ill patients who may prefer not to undergo any treatment at all, she said.

She said: "Not all people will want the same thing, nor should they. There will be a wide range of views. However an important context for this work is that in surveys of NHS patients over a number of years over one-third of people we care for and support have consistently told us they would like more involvement in decisions about their care."

The report, 'Realising Realistic Medicine', follows on from Dr Calderwood's first annual report as Scotland's CMO in 2016. She added: "The year-on-year increase in diagnostic testing activities and associated costs that has been observed and the sevenfold variation in requesting rates for some diagnostic tests further underlines the need for a broader range of professions within NHS Scotland to identify innovative ways of examining any unwarranted or harmful variation.

"Approximately 25 per cent of diagnostic tests that are undertaken are not appropriate or necessary."

Dr Calderwood pointed to the landmark Supreme Court ruling against NHS Lanarkshire in 2015 in a case brought by Nadine Montgomery, who was awarded £5.25 million compensation after successfully arguing that doctors had neglected to give her proper advice which may have led to her son, Sam, having a safer caesarean birth in 1999. He suffered brain damage during the delivery.

Dr Calderwood said: "The move away from a traditional, paternalist ‘doctor knows best’ approach will require more discussion with people about the treatment options available to them (including no treatment) as well as relevant risks and benefits.

"The Supreme Court’s judgment emphasises that discussing risk is not about potentially overwhelming people with information covering every conceivable risk. It is about having a meaningful, clear conversation and coming to a shared decision."

Dr Calderwood said citizens' jury and panel will be formed early this year to gauge public views on the concept of "realistic medicine" and the changes they want to see in health and care.

Dr Peter Bennie, chair of BMA Scotland, said: “It is good to see that the CMO recognises the need for innovation within the NHS but with the ever increasing demand and high levels of long term vacancies, the BMA now regularly hears from doctors that they do not have the necessary time to do this. We need to have an honest and open debate with the public and politicians about what the NHS can realistically provide.”

Prof Derek Bell, President of the Royal College of Physicians of Edinburgh, welcomed the report, adding: “Issues such as the overuse of clinical treatments, interventions and antibiotics remain high on the College agenda. Patients also need to be treated in the right place at the right time”.

Dr Calderwood's report also highlighted the ongoing health challenges around obesity and alcohol consumption in Scotland. Sales of alcohol are around 20 per cent higher in Scotland than in England and Wales and have been increasing since 2013, following a dip during the economic downturn.

The report adds: "In 2015, 74 per cent of alcohol was sold in supermarkets and off-licences; this was a record high. Levels of alcohol-related harm remain unacceptably high in Scotland: there are around 22 deaths on average per week due to alcohol misuse, and an average of 674 hospital admissions per week.

"Both deaths and hospital admissions remain many times higher than in the 1980s."