Intended for healthcare professionals

Editorials

Helping patients choose wisely

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2585 (Published 15 June 2018) Cite this as: BMJ 2018;361:k2585

Re: Helping patients choose wisely

Patient Choice does not exist in the NHS. It is a Fallacy, a Myth - discussed only on the rarified pages of the BMJ etc.

“Combining the doctor’s skill in evidence based medicine with the patient’s goals and preferences, can be an effective way to ensure more appropriate care.”
What does the patient do when the doctors skills are limited to only “evidence based medicine”?

“Changing the conversation from “What’s the matter with you?” to “What matters to you?”
What matters to me, as the patient, is that I get the treatment that I know from past experience over many years has worked for me.
What does NOT matter to me is whether or not the doctor thinks it is “evidence based” or not. The doctors job is to alleviate pain and illness, not to enter in to a discussion on the limited experience or knowledge he or she has of MY body.

“Helping patients choose wisely”
This statement grandly assumes that patients have no wisdom. Whilst it might well apply to many patients, there are equally many who are very well aware and informed of the best course of action to be taken.

I would suggest that “Knowledge gaps, cognitive biases, commercial pressures, uncritical media coverage”, all contribute to the current situation of medical paternalism in the NHS and should be eradicated at source to ensure that patients are no longer considered secondary to doctors.

“Patients and the public need help to understand the limitations of medical care and to avoid inappropriate or harmful interventions”
Indeed. An open and truthful approach where patients are recognised as intellectual equals would be extremely helpful.

“This will require greater investment in providing them with understandable and reliable health information than we have seen hitherto. Education in how to critically appraise medical advice would also help.21 Dealing with overuse cannot be left to doctors alone. The public also needs to be included in this important effort”
I would paraphrase this statement to read:
This will require greater education in providing doctors with further understanding and reliable health information than we have seen hitherto. Education in how to critically appraise medical side effects and publication of those statistics would also be extremely cost effective. Dealing with the restrictions and shortcomings of current medical practice must be dealt with by doctors and medical schools as a matter of urgency. The public must be included in the uptake of information which is currently presented by a mere handful of doctors in the media.

According to the Choosing Wisely website: “A doctor can only know which course of action is right for you after a discussion about your experiences of your illness; your social circumstances; your support needs; your preferences and attitudes to risk and what being well means to you. This is what healthcare professionals refer to as ‘shared decision making’ which is also summed up by the phrased “no decision about me, without me.” In a Universe far, far away…………………………………………..

Competing interests: No competing interests

16 June 2018
Karyse Day
Patient
None
Swindon