Intended for healthcare professionals

Rapid response to:


Patient choice in elective care increased emergency readmissions

BMJ 2019; 365 doi: (Published 15 April 2019) Cite this as: BMJ 2019;365:l1793

Rapid Response:

Re: Patient choice in elective care increased emergency readmissions

Healthcare, correctly delivered, is not and never can be a commercial undertaking. This is a fundamental, self evident and incontestable truth that politicians seem unable to grasp - or worse, they blithely deny as they toe the ideological line. Neoliberalism has drawn us into an amoral, asocial, seedy barbarianism from which recovery will be difficult but healthcare professionals can lead.

The only choice to be made in any clinical circumstance is, or should be, guided by such reliable evidence as is available - which should include the many risks inherent in profit driven provision, especially the potential conflicts of interest and perverse incentives.

The concept of a market in healthcare, conforming to the prevailing neoliberal theology, is fatally flawed because the 'rational agent' upon whom the entire theoretical economic 'castle in the air' is founded, does not exist. The rational agent is assumed to take account of available information, probabilities of events, and potential costs and benefits in determining preferences, and to act consistently in choosing the self-determined best choice of action. Such patients are rarae aves.

The notion of rational agent's choice is further vitiated by the circumstances in which choices have to be made when illness, injury, suffering or the apprehension of death cloud judgement.

Yours sincerely

Steve Ford

Competing interests: No competing interests

19 April 2019
Steven Ford
Retired GP
Five Stones