Why More Choice is Not the Best Medicine
By Emma.
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 do you think 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.
Friday, January 21st 2011 at 08:24
Have you never asked to see a particular consultant? Do you not prefer a particular GP?
I don’t believe you…
Friday, January 21st 2011 at 09:01
As you’ve already decided you don’t believe me (which implies you think you know the answer already), there’s probably not much point in me replying to you, but I’m bot averse to doing pointless things on the internet, so here’s my (honest, whether or not you believe me) reply:
I’ve only ever asked to see a particular doctor when I’ve been told I need to see that particular doctor (either by the doctor in question or by the doctor’s colleague, or been referred). Otherwise I just ask to see “a doctor”.
Saturday, January 22nd 2011 at 12:15
My brother has just been diagnosed with diabetes. My mum is terrified that NHS reforms in the the pipeline will leave him in exactly the position you describe. It’s a very, very real concern.
Saturday, January 22nd 2011 at 17:10
I’ve often found the idea of ‘choice’ within the NHS a bit odd, to be honest. On the one hand, I can imagine it’s a good idea but on the other, I have to ask ‘good for who?’ It’s not a new question for me, as I asked it many times under New Labour.
Generally, choice has a weird symbiotic relationship with money: the more money you have, the more choices (and opportunities &c) you have in life. The less money you have and the less choices you have about anything.
For many, choice of hospitals is restricted by real-world practicalities. Anything other than the local hospital isn’t a real option. A chance for an operation and a stay in allegedly ‘better’ hospital 30 miles away is no real option if family, friends and even the patient can’t afford to get there or the distance makes visiting impractical.
Also, when too many people make the same choice it can cause problems and increased waiting lists. I know this from personal experience. I was given the choice of treatment at three hospitals last year: one of them didn’t actually do the operation, one was impractical without a car (3 buses and over 2 hours each way).
The hospital I eventually had the operation at (a 10 month waiting list) was over-subscribed because so many people had the problem I had: actually accessing a hospital option that was too far away to be a genuine option.
Practically everyone I’ve ever spoken to about the NHS aren’t particularly fussed about choice per se, they just want good, clean local hospitals.
Also, as the article says: to make a choice, you need to be informed. It’s a bad time to want to be informed about health. Patient Information Centres or Health Information Centres in hospitals tend to be funded either by the hospital or a combination of hospital and local government funding. Now, due to cuts in both areas, I know of two hospitals where, ‘unofficially’, this particular service’s existence is hanging by a thread. I don’t think this is too much of a stretch to think that this is the case in many places.
The other avenue for health information takes us back to where the above article started: the GP. I’ve a lot of respect for most of the GPs I’ve met over the years but my trust in their opinions over treatment choices is about to take a slide. They’re about to be handed over very large amounts of money at a time when Lansley is about to open the doors for his health providing friends who are going to be very, very eager to get their hands on that money any way they can.