Many patients are struggling too

All practising clinicians are being exhorted to the dual imperatives of evidence based medicine and respect for patient autonomy. Indeed these are twin strands of the government's white papers on the NHS. Yet, these two virtuous objectives may be incompatible, and the attempted pursuit of both too often leaves the pursuer exhausted, frustrated and, above all, guilt ridden. How is the clinician to hold them in constructive tension and so interpret the evidence of medical science in the light of the individual patient's own values and priorities? Which good should prevail when there is irresolvable conflict?

The author of The Reader was born in Germany in 1944 and he …