Why More Choice is Not the Best Medicine
This is a guest post by Nik, Emma’s husband and frequent user of the NHS.
Picture the scene: a GP’s surgery. I’ve made an appointment to discuss the chest pains I’ve been experiencing for the last couple of weeks. As a diabetic of (at the time) 13 years’ standing, I’m no stranger to this environment and have calmly described my symptoms to my doctor. The doctor’s response, however, takes me by surprise.
“What do you think it is?”
I’m caught off-guard by this unexpected question. In my head I want to answer “I don’t know; I figured that as I’m not medically qualified (and know better than to submit myself to the mental torture of trying to self-diagnose by Googling my symptoms), I’m not as well-placed to answer that question as, say, someone who’s studied medicine full-time for the best part of seven years, and is paid a not inconsiderable amount to practice it as his day-job. So what doyouthink it is?” Obviously I don’t say that, partly because I’m too polite, but mostly because I actually only just figured out the wording of that reply a couple of years later. In reality I say something about how I know diabetes is linked to increased risk of heart disease and normal service is resumed.
The point still stands though – I’m no more qualified to make fundamental judgements and decisions about my own medical care than my GP would be qualified to wander into my workplace and start rummaging through Linux logs to try and figure out why a service has crashed again. Not as far-fetched an analogy as it may seem – just as my health care (obviously) affects me, my GP could be trying to access a website that depends on that crashed service. The point is that while we may care (to varying degrees – there’s a reason he’s paid more than me) about the outcome of each other’s work, neither of us would feel comfortable getting too involved in the decision-making, research and diagnoses that lead to the end results.
Almost all of us have to put our complete trust in medical professionals at one time or another. We (ultimately) pay them to know more about the human body than we could ever hope (or want) to. We also pay them (doctors, nurses and yes, managers) to be able to make choices regarding our health care. We (as patients and taxpayers) have the right to expect them to not only make these choices so that we don’t have to, but to have the knowledge to make whatever decisions will give us the best possible service and care to help make us well. (Just as we pay MPs to research and take advice about the subjects of bills so we don’t have to spend every waking moment voting in referendums – too much democracy and too much choice are equally undesirable.)
Giving patients choice over matters of little consequence other than convenience – the most obvious being when they can attend GPs’ appointments – is obviously a good thing (within reason – we can’t expect surgeries to be open for non-emergency appointments 24 hours a day). Expecting patients to make uninformed decisions about how they are treated and by whom places an unwelcome burden on them. I’m fully aware that my lifelong condition is likely to lead to complications later in life. (I try not to dwell on it too much, otherwise I’d be in a permanent state of terror.) If/when this happens, I’ll have quite enough to think about without wanting to worry about having to choose between treatment x or treatment y (at hospitals a, b or c), not least because I’ll be too busy coming to terms with the knowledge that I’ve got illness z to be able to take in any explanations of their pros and cons, no matter how beautifully marketed they are. What I’ll actually want is a highly-trained (and well-paid, naturally) doctor, with a charming bedside manner that I can literally trust with my life (because he/she isn’t competing with other doctors for my custom, but is instead working with them for my benefit) to make those choices for me.
Oh and a stethoscope around their neck, to make them look like a proper doctor, if it’s not too much to ask.
Tags:choice,NHS