Thursday, 28 February 2008

Two heads are better than one

The worst part of visiting the optician, for me, is the trial by coloured target. "Where do the black circles appear clearer - on the red, or the green?" Different lenses are passed across my eyes. "The red? Or the green?" My reply is possibly, maybe, perhaps the red is just a tad clearer? And I always long for the optician to say "that's right! Well done! The circles are clearer on the red." Instead, no matter how I try to make my answer sound like a question the optician only nods sagely and scribbles on a little card. Did I get it right? Have I made a mistake? Have I ruined my eyesight through inappropriate specs prescribed because I can't decide whether the circles are clearer on red or green?

Sir Roy Calne, in a letter to today's Lancet (access with your Athens password), says that it's the same for hospital patients. Arrive at a meeting with your consultant and she or he will offer you a swathe of options and ask you to chose one. Sir Roy describes being made to make important decisions about your own health care as akin to "being catapulted onto a tightrope wearing a blindfold, and then being asked to chose whether to jump to the left or the right". It would make sense to ask the doctor what they would chose, were they in your shoes, but "policy discourages an answer to this very reasonable and pertinent question."

The government is very keen on patient choice. A lot of this is about how, when and where you receive treatment. You can pick a hospital that is nearer to your own home, or perhaps nearer to a relative who will be able to visit. You can check to see which of the various targets your local hospitals are achieving. You can speak to friends and neighbours and find out about there experience. You can shop around, as it were, to find the best place for you.

If you have chronic illness then you've lived with it for years and years. It's not the same as being a doctor who has studied it, but you have plenty of first hand experience of what helps and what doesn't. You're considered to be an expert patient.

For the non-expert (amateur?) patients among us we can read up about our illness on the internet. The days when ordinary people had to rely on simple first aid manuals in the public library, and had no access to medical papers, are over and done. Some journals are free online for everyone to look at. We can form an opinion about what treatment we would or would not like. We might take into consideration the experiences of friends and relations who may have had the same illness. We're grown ups and we don't want to be spoken down to by an omnipotent and paternalistic doctor. We don't want to be told what to do.

However, do we really want to be left entirely to our own devices? My head aches, I pop into the chemist buy some aspirin. If the headache persists I want to be able to talk to someone who can tell me what to do about it. My sex life seems a little dull so I go online and stock up on viagra. When I ignore the warnings on the packet and my vision turns blue I have no one but myself to blame.

Roy Calne suggests we've moved from thinking that the doctor knows best to thinking that the patient knows best. Surely what is needed is a balance, a conversation between adults. On the one side the doctor has his or her education as a foundation, then CPD and reading the evidence layering on top of that, interwoven with experience of similar patients, similar cases. The patient has their own reading they have done. Perhaps, because their one interest is their own particular illness, they have read more thoroughly or more recently than the physician who has more than one illness, more than one patient, to consider. The patient has their own particular wants and needs, based on their religion, their outlook, their personal situation.

The library current awareness page covers stories on patient information, involvement and experience. We have book on consulting skills. We can help you find the best evidence to make sure you - and your patient - make the right decision, together.

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