Patients and medical power

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7325.1368 (Published 08 December 2001) Cite this as: BMJ 2001;323:1368

More debate about patient power in NHS is needed

  1. Robert Dingwall, professor of sociology (robert.dingwall@nottingham.ac.uk)
  1. University of Nottingham, Nottingham NG7 2RD
  2. 16 Roskear, Camborne TR14 8DN
  3. Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W2 1PD

    EDITOR—Canter raises important points about the problematic nature of power and the idea that it can simply be shifted from one party to another, particularly given the asymmetries of knowledge and skill that are structurally inherent in professional-client relationships.1 However, his challenge to Alan Milburn, the health minister, stops short of the crucial question about whether a national health service should seek to achieve a “decisive shift of power in favour of the patient.” The potential implication of this statement—that doctors should simply give patients what they want—is fundamentally incompatible with the ethics of taxation.

    As Canter's analysis hints but does not explicate, Milburn's statement implies that doctors should prescribe unnecessary antibiotics, carry out unnecessary surgery, and make available untested treatments—all in the name of patient power. Where does this leave the simultaneous investment in the National Institute for Clinical Excellence, evidence based medicine, and medicines management? More to the point, where does it leave the NHS on the morality of its funding from tax levies?

    In an insurance based system I can choose to pay for the level of access that I want. If I want a consumer driven system that gives me absolute freedom of …

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