Teamwork isn’t always good for the patient
‘This had been decided on by a group of doctors… who knew nothing of her preferences’
‘Two heads are better than one,” C S Lewis once remarked, “not because either is infallible, but they are unlikely to go wrong in the same direction.” And, when it comes to making important clinical decisions, a dozen heads are better still – a multidisciplinary team (MTD) of physicians, radiologists, surgeons, radiotherapists, pathologists, all meeting together, bringing their collective expertise to bear on the preferred course of action. Who could argue with that?
Back in the Noughties, BMJ senior editor Dr Tessa Richards had the misfortune of having two bouts of cancer, warranting first a major operation and radiotherapy, and, subsequently, thoracic surgery to remove a couple of metastases in her lungs. She was thus understandably distressed to learn three years ago that she had had a further recurrence.
There were, her surgeon suggested, several treatment options and he would write to her once he had reflected further. His letter never came. Instead, six weeks later, a junior doctor in another department wrote to inform her that her case had been discussed at an MDT meeting (as it is known), where it had been decided she should have a course of chemo. If this shrunk the tumour, surgery would then be considered.
Having done her own research, Dr Richards had already decided against another toxic course of chemo – but what she found really infuriating was that all this had been decided on by a group of doctors she had never met and who knew nothing of her preferences and priorities.
She soon discovered that, since her previous bouts of cancer, this had become standard practice – the MDT meet to review up to 40 cases in a morning: the relevant scans are shown, test results discussed, views exchanged and decisions rapidly made, all in the space of a few minutes.
The voices of those favouring more aggressive treatment tend to dominate over the more cautious, and the patients’ views go unheard. This, then, is the flip side of collective decisionmaking, whatever its putative merits. Dr Richards maintains that patients should insist there should be “no decision about me, without me” and the responsibility for any decision should rest not with some shadowy “team”, but the consultant in charge of their care.
No need to spend
It does not augur well that the Prime Minister’s spending plans already announced will double the budget deficit and now match those of Jeremy Corbyn. The Health Service predictably is a major beneficiary of his largesse, with an extra £2billion to add to the £140 billion annual expenditure – a staggering fivefold increase (an additional £110billion) compared to 25 years ago.
For all the protestations to the contrary, the Health Service’s difficulties are not financial, but cultural and organisational – stemming from the series of radical (but poorly thought-out) reforms inflicted on it by Tory and Labour administration since 1989.
The many adverse consequences of overregulation, box-ticking and lack of accountability are potentially correctable without spending an extra penny – a worthy project that regrettably will not feature in the Queen’s Speech. Meanwhile, next week, the much-praised documentary Under the Knife, on the trials and tribulations of the NHS, is being screened for free across the country. Check undertheknifefilm.co.uk for the nearest venue.
Driven to tears
Finally, this week’s query comes courtesy of a self-confessed alpha male in Dorset running his own business, active in local politics, chairman of this and that. Over the past couple of years, he has become tearful at the slightest provocation – listening to music, reading a sentimental poem, or seeing distressing images on the news.
Recently, he was quite unable to deliver the eulogy at a friend’s funeral. “While not ashamed of weeping in public, to do so often with little inducement is extremely embarrassing,” he writes. Might there be any hints as to how he can regain emotional control?