My role


Patient choice: the reddest of herrings

Patient choice is probably the worst thing to happen to medicine since the leeches went out of fashion says Jim Pollard, editor of the Men's Health Forum's websites. He argues that there's something far, far more important to patients than choice which both doctors and government are neglecting.


Choice is like democracy, freedom or a threesome - one of those words that sounds like it must be a good thing.

To listen to the British government you'd think choice was the greatest thing to happen to medicine since the leeches went out of fashion. 100mcg of choice three times a day. Of course, it's not choice as such that interests the British government, it's the opportunity that so-called choice will provide to embed the thin end of the free-market wedge still further into the back of the lumbering frame of the NHS but that's another story.

The trouble with choice from the patient's point of view is that you can only exercise it if you know what you're choosing from. How do I know who is the best consultant for me to see? Until a GP referred me to one, I had no idea what an oncologist was or did so how could I have referred myself?

No, there is an issue that is far more important to patients than choice.

My oncologist has since referred me on to, amongst others, an endocrinologist, a urologist, a gastroenterologist and they're just the ones I can remember. The reason for all this to-ing and fro-ing is simple. To me anyway, if not always, it seems, to my physicians.

I am now in remission from Hodgkin's Disease - which is fantastic and I'm very grateful to the doctors and nurses of St Thomas's Hospital, London for it - but as a result of my successful treatment with radiotherapy and chemotherapy, I have a fried thyroid and other ongoing secondary problems. Sure, these various specialists write letters to each other but these are, let's be honest, merely glanced at during a consultation if that. It's down to me to make the links and ask if what X said about Y might be related to the problem A is treating me for with B. A good way to test that I'm paying attention, perhaps, but when it come to efficient use of resources — both mine, mental and physical, and the NHS's — very far from ideal. Words like cat, chase and own tail come to mind.

Traditional western medicine hacks the human being into pieces placing the different organs, systems and body parts in separate, neatly labelled boxes. But what happens when we fall outside the established parameters or, as in my case, are no longer so neatly classified? Hopping from one box to the other is tough for me and I have considerable advantages over many patients. I write about health so I ought to know a little bit about it.

This compartmentalisation may have made sound scientific sense once but it makes no sense today. Patients don't see themselves as boxes of different bits so in these non-deferential, more individualistic times , the doctor find himself or herself getting off on the wrong foot straightaway. Contemporary research suggests that patients are right not to take this view — everything is connected to everything else, after all - and, increasingly, the best doctors are those who can think outside of the box.

One of the main attractions of so-called alternative or complementary therapies to patients is that the therapist treats the whole person. They talk to you as an individual with your own lifestyle, personality and history. What a blessed relief that is. I don't buy my therapist's explanation of why Chinese medicine and acupuncture work — I'm not even sure they do work - but what I do value enormously is the opportunity to discuss my health problems and my life with him in a global, holistic way. Many of the questions I've asked my doctors have been generated through these sessions. It's partly down to time I know — NHS doctors don't have a lot of it — but it's also down to an attitude, a way of seeing health, that is an impediment to the basic objective of the whole business which should surely be to make the patient feel better.

How would increased choice help me to feel better? All the specialists I've seen have been at the same hospital. And in my situation, who would choose otherwise? It's complicated enough without opting for a consultant in Croydon, a blood-test in Birmingham and a DRE somewhere far, far away. Factor in that health-boosting six hours in a traffic jam and the nutritious motorway service station lunch and the absurdity of choice as a medical panacea becomes obvious.

No, choice is a large, lifeless herring that has been liberally doused in scarlet. Patients don't want to be treated at a time and place of their choice by surgeon who got five stars for scalpel dexterity in Which Physician? magazine, they just want to be treated as a person.

In the past doctors were trained first in the human body, then in the things that can go wrong with it and finally in how to treat them. I am told that ideas are changing and today's students are being taught in pretty much the opposite way. This places the patient and his or her presentation first which is a welcome step. However, both new and more experienced doctors alike need to understand that each patient is more than the set of symptom with which they present.

So how would the patient like the doctor to demonstrate that? It's not always easy and requires social skills that are not natural to everyone but a good start would be for doctors to listen and reflect a little more and, for some of them, to speak a little less. I'd prescribe a good three or four minutes of listening and reflecting at the start of each appointment.That would be my choice.

  • A longer version of this article was originally commissioned for European General Practice magazine.

Page created on August 1st, 2005

Page updated on December 1st, 2009