The current political agenda for choice in medical care is being presented as something new. However, choice has always existed. Not everyone who is ill chooses to seek medical care. For example, 50% of women with heavy periods (blood loss of > 80 ml in each period) do not complain, whereas 50% of those who seek treatment have bleeding that objectively is in the normal range.

There has long been a choice about whom to consult. Many people with acute symptoms prefer to visit the hospital's emergency department rather than seeing their family doctor. Many seek second, or even several, opinions. This option—long available to the wealthy—has been encouraged by medical specialisation. For example, many women lose babies because of going intolabour before term. They are desperate to avoid are petition. They often consult widely and may be seen by a haematologist looking for a thrombophilia, an infertility specialist to help …