{
  "abstract": "Overdiagnosis requires a number of actions and these are clearly described in the literature, but what is also needed is a change in culture, a cultural revolution. David Eddy described what he called, ‘ the relentless increase in the volume and intensity of clinical practice’, and this has been a culture of believing that more is better, complicated of course by fears of litigation and therefore defence medicine. The key culture that is required to tackle overdiagnosis and overtreatment is the culture of stewardship, where stewardship is being responsible for a resource that you do not own but need to protect and develop for future generations.Without a culture of stewardship, created by the leadership of an organisation, the management of that organisation cannot control behaviour of clinicians. The culture of stewardship has to imbue clinical thinking and clinical practice as recommended by the Academy of Medical Royal Colleges in their 2014 report.One doctors’ waste is another patient’s delay. Potentially, it could be that other patient’s lack of treatment….A cultural shift is required which calls upon doctors and other clinicians to ask, not if a treatment or procedure is possible, but whether it provides real value to the patient and genuinely improves the quality of their life or their prospects for recovery….Doctors should embrace the values of resource stewardship in their clinical practiceWithout a culture of stewardship and the management of what Nobel Prize winner Elinor Ostrom called, ‘common pooled resources’ what develops is the Tragedy of the Commons first described by William Foster Lloyd, Professor of Political Economy at Oxford in 1833 working in Christ Church and walking in Christ Church meadow about two hundred yards from the Examination Schools.‘If a shepherd put more than his allotted number of sheep on the common, overgrazing could result. For each additional animal, a shepherd could receive additional benefits, but the whole group shared damage to the commons. If all shepherds made this individually rational economic decision, the common could be depleted or even destroyed, to the detriment of all.’This presentation will describe how a culture of stewardship can be created by moving to population healthcare with clinicians being given responsibility for the ‘common pooled resource’ for their segment of the population for example for people with respiratory disease . there is also a need to move to a new language in which waste is not only due to inefficiency but also to the use of resources which would give more value if switched to another intervention for this group of patients or to another segment of the population altogetherObjectives To inform people about the need to create a culture of stewardship.Method Discussion with objective settng.Results Workshop report.Conclusions People will understand the importance of culture and the concept of stewardship.",
  "authors": [
    {
      "affiliations": [
        "Nuffield department of primary healthcare, oxford, UK"
      ],
      "name": "Muir Gray"
    }
  ],
  "title": "115 The need for a culture of stewardship",
  "uid": "8b7795a9-f5d5-504e-aa78-379f87d74957"
}