Money isn’t the most critical resource—we need to consider time and carbon

Muir Gray, Anant Jani In the past two months The BMJ has published articles on unnecessary preoperative tests,1 on excessive prescribing of proton pump inhibitors,2 and on unnecessary laboratory tests on inpatients,3 and there have been two shrewd commentaries from Giles Maskell on the inexorable growth of imaging.4 5 These are all consistent with the Too Much Medicine campaign that the journal launched five years ago. The focus of these articles has been on the financial cost of these tests, and it is obviously essential to shift resources from zero or negative value activity to high value activity, either in the NHS or in other essential health services. One fifth of children in Oxfordshire, for example, are obese when they leave primary school, with more financial cuts to education in the pipeline. But finance is not the most critical resource. These tests and their false positives consume the two other resources that are more important—one is the time of clinicians and patients and the other is carbon. Results should be presented in terms of these two currencies not only because of their inherent importance but also because the opportunity for saving time and carbon would be much more powerful motivators than yet another appeal to clinicians to save money.