It was interesting to read the editorial and the subsequent rapid
responses on transfer of power from doctors to patients. I think that the
word and meaning of power has been taken out of context. A different
interpretation would be that it is not a mere manifestation of power when
a doctor influences a patient in what he believes is right, but rather
that it is the doctor’s duty to do so. A doctor is duty-bound to explain
the choices and failing to do so would be falling foul of GMC regulations.
That such regulations exist, means that such power is not in a doctor’s
hands but elsewhere. Of course, the doctor can only explain the choices as
he understands them. That is why it is the doctor’s responsibility to keep
his knowledge continually up-to-date, by keeping abreast of the latest
research, guidelines, and practices. This is again determined by the GMC
and the various Royal Colleges.
Patients have power not only due to informed consent (which compels
the doctor to explain the alternatives, risks, and benefits of a procedure
– and rightly so), but also by being able to request a second opinion
before and after treatment. If anything should be unsatisfactory in the
conduct of the physician or the care given, then the patient is always
able to complain. Many research articles have shown the power of a
complaint in modifying a doctor’s behaviour. This is after the
consultation, but even so it shapes future behaviour.
As for the conventional biomedical framework Richard Canter mentions,
that has always been inherent in doctors’ approach to treatment and care.
Patients know that they will probably not be offered so-called
complementary medical alternatives (hence their name), and they are also
free to use those therapies if they wish. Whether other paradigms should
be considered is a matter for Alan Milburn, and the governing bodies to
determine. Conventional medicine is nothing more than medicine that has
been scrutinised carefully for its effect, and proven to have a beneficial
effect. Whether the complementary medical alternatives should be included,
depends solely on their merits, and unless there is evidence of their
benefit, doctors will naturally be reluctant to include them in their list
of choices.
Doctors will always exhibit this kind of ‘third-dimensional power’ in
any personal interaction, as in a consultation. However I do not think it
is fair to say doctors control the world as the patient sees it – as
though it is deliberate. It is true that third-dimensional power can be
hard to recognise and can be abused, but in the majority of the
profession, it is not a sinister attempt to lure the patient into
believing what we want them to. The doctor will give information
impartially to the best of his ability, but, as with any human, it will
inevitably be slightly coloured by his own views, beliefs, and attitudes.
This is going to be inevitable in any interaction in which one person is
imparting information to another. An analogy would be that of taking a car
to the mechanic. The mechanic will explain the problem briefly and go
about fixing the car. Yet we do not complain of power in this situation –
we do not expect the mechanic to take into account our opinions, or to
offer to phone a second garage so that we can be sure he has correctly
identified the problem. And if new garages are set up on the belief that
cars can be repaired using psychic powers, then we do not expect the
mechanic to take account of that alternative theory of repair. We just
want a working car at the end. Naturally this is tongue-in-cheek, and
medical interactions are more complex, but some of the basic principles
about power still apply.
A shift in the balance of power ‘decisively in favour of patient’
favoured by Alan Milburn, sounds laudable, but in essence means nothing. A
doctor has more knowledge (and also obligations to the taxpayer – as
Robert Dingwall mentions), and that is the source of his power. In a
consultation, doctors should strive to have a mutual relationship, in
which patients understand all of the issues regarding their treatment, and
if that aim is met, both parties should be satisfied. Even achieving this,
in the present NHS, when consultations are only a matter of minutes, is by
no means an easy feat.
Rapid Response:
Power and Duty
Dear Sir
It was interesting to read the editorial and the subsequent rapid
responses on transfer of power from doctors to patients. I think that the
word and meaning of power has been taken out of context. A different
interpretation would be that it is not a mere manifestation of power when
a doctor influences a patient in what he believes is right, but rather
that it is the doctor’s duty to do so. A doctor is duty-bound to explain
the choices and failing to do so would be falling foul of GMC regulations.
That such regulations exist, means that such power is not in a doctor’s
hands but elsewhere. Of course, the doctor can only explain the choices as
he understands them. That is why it is the doctor’s responsibility to keep
his knowledge continually up-to-date, by keeping abreast of the latest
research, guidelines, and practices. This is again determined by the GMC
and the various Royal Colleges.
Patients have power not only due to informed consent (which compels
the doctor to explain the alternatives, risks, and benefits of a procedure
– and rightly so), but also by being able to request a second opinion
before and after treatment. If anything should be unsatisfactory in the
conduct of the physician or the care given, then the patient is always
able to complain. Many research articles have shown the power of a
complaint in modifying a doctor’s behaviour. This is after the
consultation, but even so it shapes future behaviour.
As for the conventional biomedical framework Richard Canter mentions,
that has always been inherent in doctors’ approach to treatment and care.
Patients know that they will probably not be offered so-called
complementary medical alternatives (hence their name), and they are also
free to use those therapies if they wish. Whether other paradigms should
be considered is a matter for Alan Milburn, and the governing bodies to
determine. Conventional medicine is nothing more than medicine that has
been scrutinised carefully for its effect, and proven to have a beneficial
effect. Whether the complementary medical alternatives should be included,
depends solely on their merits, and unless there is evidence of their
benefit, doctors will naturally be reluctant to include them in their list
of choices.
Doctors will always exhibit this kind of ‘third-dimensional power’ in
any personal interaction, as in a consultation. However I do not think it
is fair to say doctors control the world as the patient sees it – as
though it is deliberate. It is true that third-dimensional power can be
hard to recognise and can be abused, but in the majority of the
profession, it is not a sinister attempt to lure the patient into
believing what we want them to. The doctor will give information
impartially to the best of his ability, but, as with any human, it will
inevitably be slightly coloured by his own views, beliefs, and attitudes.
This is going to be inevitable in any interaction in which one person is
imparting information to another. An analogy would be that of taking a car
to the mechanic. The mechanic will explain the problem briefly and go
about fixing the car. Yet we do not complain of power in this situation –
we do not expect the mechanic to take into account our opinions, or to
offer to phone a second garage so that we can be sure he has correctly
identified the problem. And if new garages are set up on the belief that
cars can be repaired using psychic powers, then we do not expect the
mechanic to take account of that alternative theory of repair. We just
want a working car at the end. Naturally this is tongue-in-cheek, and
medical interactions are more complex, but some of the basic principles
about power still apply.
A shift in the balance of power ‘decisively in favour of patient’
favoured by Alan Milburn, sounds laudable, but in essence means nothing. A
doctor has more knowledge (and also obligations to the taxpayer – as
Robert Dingwall mentions), and that is the source of his power. In a
consultation, doctors should strive to have a mutual relationship, in
which patients understand all of the issues regarding their treatment, and
if that aim is met, both parties should be satisfied. Even achieving this,
in the present NHS, when consultations are only a matter of minutes, is by
no means an easy feat.
Competing interests: No competing interests