Medicine and patient choice.

[Admin]

It's quite a popular notion that we as consumers should have as much choice as possible regarding our medical care. I wonder just how wise this is.

A lot of people go along with the idea of alternative remedies being given on the NHS for example. The basic idea is that we go to the doctor's and (s)he will diagnose your complaint and then offer you several treatments including alternative treatments. You as the patient decide what course of action to take.

Superficially it sounds fine; however, I argue against this in the following way:

Suppose you go to the doctor and something is diagnosed. The doctor then calls someone from the waiting room and asks them to decide which treatment you should have. Would you be happy with your treatment being chosen by someone who has probably zero medical knowlegde?

If you answered "no", what makes you any more qualified to decide your own treatment than another layperson?

I'm all for a bit more information from doctors, but I would leave medical decisions in their hands - they're the professionals.

Most of us wouldn't even think of attempting to build a wall, rewire the house, or strip a car engine down (and hope to put it back together in working order), so what is it that makes us think we're capable of making medical decisions?

It does surprise me that many people who willingly admit that they are incapable of programming a video recorder will nonetheless often self-diagnose their conditions and treat themselves with alternative remedies!

Personally, I think this "patient choice" issue will not go away as it is popular and that makes it politically desirable.

[Mongrel]

My opinion is that minor and self limiting ailments - choice, but properly explained "Homeopathy has failed any well set up test that it's been put through" ::). More serious stuff should go back to "Doctor knows best" philosophy, he spent many years training to put that GP on his door.

Why are we, generally, happy to accept a machanics word that the car needs to have X,Y and Z done to pass it's MOT but I have to put up with "What do you want to do?"* when my Insomnia kicked in badly a few months ago?

[ranty bit]
*Note - The choices were:
1) I print out the Sleep council (http://www.sleepcouncil.com/consumer_room/sleep_tips_2.cfm) list for you, because even though I know your GF is a Pharmacist and you mentioned trying all of them it never hurts.
2) Tablets with funky side effects that work, just not for too long
3) A patronising talk and more print outs
The correct answer is of course "I just want to go to sleep!!! This is your job"
[/ranty bit]

[Physiotherapist]

Mongrel,

Sometimes people do need to take responsibility for their own health, rather than handing everything possible over to a doctor. It is your body and you need to take an interest in it. A doctor can give you all the information needed so that you can make an informed decision.

Insomnia also has many causes, some of which can be psychological, so sometimes throwing drugs at a problem is not always the best solution.

[Aardvark]

I think what the Government is looking for is 'Informed Consent'

A good example of this is when my wife took our child to see the local GP. My wife and I had discussed that we would prefer his hayfever to be managed initially by a topical antihistamine and that we did not think a steroid was approriate at this early stage.

This was communicated by my wife to the GP during her consultation with our child.

The GP listened and issues a script FP10.

My wife showed the FP10 to me that evening before presenting it to the local Pharmacy. The GP had ignored her request and issued a steroid.

The Next day my wife asked the GP why and he said he did not believe that antihistamines worked. My wife registered with a different GP practice the same day.

[Admin]

I think what the Government is looking for is 'Informed Consent'


My problem with the approach lies in the 'informed' part. It depends on where the information is coming from.

If doctors are prescribing treatments that are clinically proven (appraised by NICE) then giving the patient a choice based on say benefits vs side effects then that is a good thing.

On the other hand, if we go down the 'integrated medicine' route and 'alternative medicine' is included in the patients' choice then many people will end up making bad decisions.

It may never happen of course, but many people, like Prince Charles for example, do have this concept in mind for the NHS.

[Aardvark]

Ah yes, now I think I follow the gist of this thread.

1 Alternative medicine may bring in extra votes, especially from the woo woo section

2 It looks like the NHS is modernising ane embracing whole patient treatment approaches

3 Alternative medicine is not easy to audit as there are no national outcome standards and no NICE

4 Alternative medical practitioners do not take 14 years to become consultants and all that training cost

5 Alternative medical practitioners, whether you believe them to be Charlatans or not, do not cost as much in wages as a decent nurse

6 Prince Charles, bless him. is just a touch 'spacey' and should be wearing an orange robe and clanging his finger cymbals

If you want a placebo effect, go what makes you feel better, a small sherry or port, a good film, a holiday, a bar of Cadbury, 2 jags and a secretary??