The past 15 years have seen the issue of patient choice being highlighted in the mass media as a positive way forward for the NHS. The Labour Party used it as a key point in their manifesto for the election in 1997, when Tony Blair was elected. It is also mentioned as part of the reform of the NHS currently being reviewed in the House of Commons - although many just see it as a cover up for the proposed cuts.
Patient autonomy is surely a good thing for patients; it allows them to make reasoned decisions for themselves. Well, this might be great for medical ethics, but the majority of patients don’t have an expert knowledge of how their bodies work and the effect of treatments upon it. Would it not make sense to have the doctor, who has been put through a great deal of training and has much more experience of these situations make the choice for them?
How can our patients be expected to read, understand and weigh-up the pros and cons of the medical literature regarding their illness? Thanks to the rise of the internet there is a mountain of information on health accessible to the masses, but often they do not have the skills to critically appraise the data and studies they find. Knowledge without understanding is dangerous, as it can lead us to make poor decisions with confidence.
Many patients are unlikely to even find the information they need to make an informed decision. There is an accessible and easy to use site called NHS choices. But first consider that a large proportion of patients that require medical care are elderly, and 60% of over-65’s have never accessed the internet in their lives. This makes their job of assessing how and where they would like to be treated a great deal more difficult.
As far as the tax payer is concerned, it makes no sense to pay a great deal of money to train doctors if they are no longer going to make decisions. Undoubtedly it would be much cheaper to have a nurse hand them a leaflet about each treatment. But why isn’t this happening already? Because the lay person needs an expert opinion, and they don’t want to make a potentially fatal mistake.
Furthermore, a doctor is able to take a much more objective view on the situation, removing as much emotion from the decision as possible. Sometimes the best treatment is not always the most obvious, or one which the patient would ever decide upon.
Of course, all patients will decide that they want the gold standard treatment. Looking at the current NHS budget restrictions, it hardly seems financially viable for every patient to receive the very best (and usually most expensive) care. Rationing of services to those who need it most and will get most benefit is what differentiates the NHS from private healthcare providers, and allows the service to remain free at point of access for everyone - one of Bevans underlying principles of the post war health system.
Then we come to choice over primary care services. GPs are distributed to make sure that there are enough doctors per area, and to meet the needs of the local population. If patients start to choose exactly which GP they see and where, this will undermine the whole system that was put in place. This would inevitably lead to greater waiting times, which can’t be good for the health of the local population.
Waiting times are likely to increase...
An increase in waiting times isn’t exclusive to primary care. As patients get increased choice over where they are treated, the newer, nicer looking hospitals with a good reputation will suffer from exponential growth in lengths of their waiting times. Resources are carefully planned so they will meet the needs of the local population. If people start flocking to certain hospitals from further away, the provision of care will no longer be evenly spread, leading to a distortion to the care that patients receive.
Should everyone be allowed choice over their own health care? Surely some people will be more competent than others. Without a way of distinguishing between these levels of competence, we cannot vary the choices we give to patients. It would be very dangerous to start giving everyone control of their own care, but we can’t deny everyone on the basis that some people aren’t competent either.
Having control over our own care does make the majority of people happy as they have control over that area of their lives. However, I’m not sure this is for the benefit of their health, and is instead a concept used to win over a few extra votes for whichever political party wants to flaunt it.
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