Giving patients choice puts more pressure on GPs, survey shows
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.522-a (Published 04 September 2003) Cite this as: BMJ 2003;327:522
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The title of this news item is dangerously misleading. The survey
does not show that giving patients choice puts more pressure on GPs. It
shows that patients and GPs fear that giving patients choice may put more
pressure on GPs, and that is a very different matter. The views expressed
by both clinicians and patients are so speculative as to tell us no more
than that there is much educational work to be done within both camps.
Alan Maynard should know better than to set running such speculative hares
as his.
At the centre of all of this – and of Say and Thomson’s far more
significant paper, “The importance of patient preferences in treatment
decisions – challenges for doctors” – is a shared understanding of the
grotesquely named ‘expert patient’. The term is widely misunderstood and
misused, conjuring up pictures of patients clutching huge sheaves of print
-outs from the Internet and lecturing clinicians on their condition and
its treatment. Such people are not expert patients; they are opinionated
patients, and it is not surprising that they strike terror into doctors’
hearts.
Technically, the real ‘expert patient’ is one who has been through
the Expert Patient Programme, based on research pioneered by Kate Lorig at
Stamford University in the United States, validated by similarly excellent
work done at Coventry University, promoted as the Living with Long-Term
Illness Project by the Long-term Medical Conditions Alliance and adopted
by the Department of Health as a means of improving the management of
chronic illness. In its purest form, it is about lay-led self-management,
but there is scope for flexibility.
Of at least as much importance to patients and health professionals
alike are the benefits to be gained from educating patients. It is as
wrong to suppose that patients may be expected to make sensible, informed
choices about their treatments without being educated to do so as it is to
suppose that busy clinicians have time to do much patient education on the
hoof. Along with the concept of patient involvement in decision taking
must go comparable concepts of patient education and patient
responsibility. If those ideals can be translated into reality, then
people using health services may be expected to become ‘educated patients’
or ‘well informed patients’ – and that will help everyone.
Competing interests:
None declared
Competing interests: No competing interests
I strongly recommend not to trust in guidelines declaring
type II = obesity and lack of bodily exercise associated
dyslipoproteinemia to be something requiring the same treatment as an
endocrinological disease = primary lack of insulin in the peripheral
tissues = type I Diabetes mellitus.
Competing interests:
None declared
Competing interests: No competing interests
Finding a new plumber
Before attempting to answer BUPA’s question “Can we afford the
informed consumer?” we need to consider why the issue of the “expert
patient” arose in the first place.
Most of those who have become part of the iatrogenic statistics
learnt the hard lesson that very often, their survival depends upon their
own research and therefore their ability to make informed judgements about
treatment. To blindly accept the opinion of the busy doctor who cannot
remember the details of the patient’s case and who, in under five minutes,
determines what to prescribe, often results in further injury if not
death.
Alan Maynard, professor of health economics at York University,
typically puts the doctor’s interests over the welfare of the patient: "We
have to guard against the possibility that the ‘expert patient’ with the
right information and an understanding of the system, monopolises GPs’
time."
In short, the preferred clientele is the ignorant clientele for they
are not a threat to the power the profession wields; nor do they
represent threats to income and (perceived) superior status.
The informed consumer on the other hand, feels quite justified in
asking, “What makes the GP’s time more valuable than mine?” He
recognizes that the GP is paid for a service and a service is what he
wants but rarely gets within his allotted five minutes. No wonder more
and more sick people are looking to alternative treatments. After all
even a doctor who is dissatisfied with his plumber, finds a new one.
Competing interests:
None declared
Competing interests: No competing interests