‘We must accept that health care is a risky business’

BMJ 2003; 326 doi: (Published 12 June 2003) Cite this as: BMJ 2003;326:1333
  1. Peter Walsh (, chief executive
  1. Action for Victims of Medical Accidents, London CR0 1YB

    One of the thorniest issues in the relationship between doctors and patients has been how to deal with a dispute. The rhetoric of the past few governments, both Conservative and Labour, has emphasised the need to treat patients as consumers of services provided by the NHS. Patients need to be “at the centre” of all arrangements for planning, delivery, and accountability. At the same time, the private healthcare system in Britain has grown by aggressively marketing its service as modern and responsive to patients' needs as “customers,” and patients are becoming used to making choices both about who provides their services and the nature of the treatment they are to have.

    The growth in consumerism has been accompanied by an explosion in information systems, most notably the internet, which have made patients more knowledgeable customers when it comes to disease, treatments, and patients' rights. Recently, information on the performance of hospitals has become available through private initiatives such as the Good Hospital Guide,1 and the Department of Health plans to publish more detailed information on the performance of individual consultants.

    Where we are now

    When there is a dispute, however, the relationship between doctors and patients can still seem rather paternalistic. Feedback from community health councils, which support people with complaints, suggests that many patients still get removed from general practitioners' lists for no other reason than having dared to complain about their doctor's service or attitude. This is in spite of guidance from the Royal College of General Practitioners that all attempts to resolve disputes should be exhausted before declaring the doctor-patient relationship and trust irretrievably damaged.2 In …

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