Should you tell patients about beneficial treatments that they cannot have? Yes

doi:10.1136/bmj.39171.426690.AD

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Robert Marcus, consultant haematologist

Addenbrooke's Hospital, Cambridge CB2 2QQ

robert.marcus{at}addenbrookes.nhs.uk

No healthcare system can afford to pay for all available treatments. Robert Marcus believes doctors have a duty to tell patients about unfunded drugs, but John Firth argues that it will cause them harm

A man who is losing vision in both eyes from macular degeneration seeks the opinion of an ophthalmologist. The doctor knows there is a new treatment that might save the sight of one or both eyes. It is available and doctors are able to prescribe it. But the treatment has not been approved by the National Institute for Health and Clinical Excellence and primary care trusts are refusing to pay for it. What should the ophthalmologist do?

We are not discussing a treatment that the patient wants but that the doctor considers is inappropriate. It is a treatment that is appropriate but cannot be offered purely for financial reasons.

The patient may or may not be willing to pay for it himself; may or may not have family willing to pay; and may or may not be able to sell his car, which he is unable to drive …