Advice on health? Doctor does not always know best
PATIENTS are being urged to question doctors about whether they really need tests or treatments.
Scotland’s Chief Medical Officer yesterday called on NHS staff to be more ‘realistic’ with patients about the benefits and risks of procedures.
Launching a major drive to get away from the ‘doctor knows best’ culture, Dr Catherine Calderwood said patients should ‘challenge’ decisions.
The terminally ill should be given the choice of refusing interventions and opting for ‘quality of life over length of life’.
The latest annual report by the Chief Medical Officer (CMO) aims more fully to involve patients in decisions about their care, as well as reduce harm and unnecessary procedures.
The concept of ‘realistic medicine’ puts the patient at the centre of decision-making and creates a personalised approach to care.
In a message to patients Dr Calderwood said: ‘You should consider carefully the value to you of anything that is being proposed whether it be a treatment, consultation or a diagnostic investigation and be prepared to offer challenge if you feel it appropriate.’
The approach is being adopted throughout the NHS but could make the biggest impact among the elderly or those at the end of life. Dr Calderwood added: ‘We know from research that doctors, particularly at the end of life, would choose different treatments, perhaps less intervention, less medication, than they would offer to their patients.
‘Why would we be doing something different to what we would talk to our patients about?
‘I’ve really started to ask this question, what are the priorities for people? And in fact, particularly with a terminal diagnosis, most people do not necessarily want to live longer, they actually want to be symptom free and they particularly want to spend time with their families.’
She acknowledged the approach would require ‘honest conversations’, particularly for patients with a terminal condition.
One project, backed by the CMO, has already been launched in NHS Borders advising patients to ask their doctors ‘five questions’.
They include whether a test, treatment or procedure is ‘really needed’ and what the ‘benefits and downsides’ are, as well as side-effects. The questions also include whether there are any simpler or safer options and ‘what would happen if I did nothing?’ Dr Calderwood added: ‘Any patient and person who needs a treatment, who chooses a treatment or decides that a procedure or a medication is the right thing for them, they will still have that treatment. This is about doing the right thing for those people.’
A citizens’ jury will be used to gauge public views on realistic medicine and the changes they want to see in health and care.
Dr Peter Bennie, chairman of the British Medical Association in Scotland, welcomed the report but said it was time for an open debate about what the NHS can ‘realistically provide’.
He said: ‘We welcome the CMO’s commitment to help the wider public engage with realistic medicine and understand what it will mean for them.’
But he said with the ‘everincreasing demand and high levels of long-term vacancies, the BMA now regularly hears from doctors that they do not have the necessary time to do this.
‘We need to have an honest and open debate with the public and politicians about what the NHS can realistically provide.’