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Rapid Responses: Rapid Responses published:
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An important issue highlighted
- Graham LG McAll (3 May 2005)
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The informed patient and quality of care
- Peter D Singleton (5 May 2005)
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Advantages, too
- Mira de Vries (5 May 2005)
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Graham LG McAll, General Practitioner 126, Devonshire Street, Sheffield, S3 7SF
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Recently I have had several patients attend as a result of being frightened by advertisements in the popular press. They had seen and responded to an advert asking if their family was infected with fungus. They had sent away for the offered literature and then attended and requested an antifungal tablet by name. Diagnosis of tinea nail infections was confirmed and they wished to be treated with the stated drug despite the risk profile, expense to the NHS and the harmlessness of the condition. Is this freedom of information and patient autonomy or scare-mongering and commercial opportunism? Competing interests: None declared |
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Peter D Singleton, Senior Associate Judge Institute of Management, University of Cambridge, CB2 1AG
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The most interesting result from this study is not that patient requests influence the choice of treatment, which is good to hear, but that minimal acceptable care was given in only 56% of cases where the patient made no request for drugs (general or specific). Considering Type 1 and Type 2 errors (Editorial, BMJ 2005;330 (30 April)), it would seem that DTCA helps to generate correct treatment more than it leads to incorrect treatment (inappropriate choice of drug). My immediate reaction is not to recommend DTCA (there are far too many caveats to be applied), but to query why clinicians needed to be prompted to provide a minimal level of care. This is not to pillory doctors, who have much to contend with (including ‘standard patients’), but to consider whether we need improvements in the use of care protocols and decision-support systems to improve the quality and consistency of care. Dr. McAll’s comment concerning the ‘harmlessness of the condition’ may suggest that doctors take a very ‘medical’ view of the problem without considering the impact on the social life and sense of well-being of the patient. He is right to suggest that the drug treatment is probably not the best choice as a first option, but nor is ignoring the condition as ‘harmless’, especially when the patient has clearly gone to some trouble to find out about their condition before bothering their doctor. Being ‘empowered’ by information may enable patients to push for the treatment they need – doctors too need to be empowered by information about best practice and effective alternative treatments – plus ready information to give to patients to support their recommendations. Competing interests: Co-author of 'The Informed Patient' reports, produced under unrestricted research grants from Johnson & Johnson |
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Mira de Vries, chairman Assoc. for Medical and Therapeutic Self-Determination, P.O. Box 761 1180 AT Amstelveen Netherlands
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By hiding medical advertising from consumers, physicians’ decision- making processes are kept opaque and mystified. At the same time, advertisements are shielded from scrutiny by the people who use the product. It is, for instance, thanks to direct to consumer advertising in the United States that claims for the non-addictiveness of antidepressants were challenged. Problems of public funding of unnecessary treatments can be easily solved by allowing the consumer to purchase the desired product freely, without prescription, and at his own expense. Competing interests: None declared |
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