Views & Reviews From the Frontline

Patient leaflets are worthless

BMJ 2012; 345 doi: (Published 12 December 2012) Cite this as: BMJ 2012;345:e8336
  1. Des Spence, general practitioner, Glasgow

In the 1990s our offices were crammed with stuff: plastic joints, stress balls, wall clocks, and broken lamps—nobody was seemingly able to resist pharma’s freebie tat, however useless. I also had a pile of textbooks but most clinical knowledge remained in the head of the local specialist. But the greatest space culprit was the patient leaflets, deemed the “must have” for the empowerment of patients. Filing cabinets were jammed closed with leaflets for everything, spewing across the desks and on to the floor.

Research suggested that patients retained nothing that they were told in consultations. But I could never find the right leaflet, giving young men the menopause and HRT ones and children the smoking cessation ones. Anyway, the health centre car park was not only full of empty chip papers and cigarette ends but also hundreds of unread information leaflets. And most leaflets were just pharma marketing propaganda, masquerading as education.

In 1996 I plugged a computer into a deafeningly noisy modem, the world opened up, a Damascus moment. All knowledge was now a few clicks away. What I thought I knew was out of date or just plain wrong. I binned my textbooks. When an avalanche of leaflets crashed over my floor, I realised that leaflets were no longer relevant either, riddled and rotten with bias. I sentenced them all to landfill too. The antique web browser AltaVista became my tutor, and expert knowledge soon lost its coinage. Today the difference in clinical practice between doctors is one of mere opinion. And this medical opinion is based not only on experience but more importantly on the doctor’s own health beliefs. For example, a belief in the benefit of breast screening means certain doctors promote screening despite the conflicting evidence.

So my room is largely empty. I might on occasion print out a leaflet for a patient. But in the main I suggest people research conditions themselves on the internet from many sources, suggesting initially various NHS sites. But there are many other opinions too—blogs, charities, discussion forums, and the rest—that are worth reading. Medicine has no definitive answers, just opinion and uncertainty. The internet might be dangerous from the perspective of patients trying to diagnose their own problems, but once they have a diagnosis, it empowers patients in a way that leaflets never did. The recent debate about official leaflets for breast screening is an irrelevance.1 Even official leaflets are never truly impartial, always open to the bias of the authors’ clinical beliefs. The genie is out of the bottle. The power once derived from knowledge is dead, and patient leaflets aren’t worth the paper they are written on.


Cite this as: BMJ 2012;345:e8336.



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