Choice is only half the story
Choice is one of the Government's health mantras. Give patients more choice in treatment, both in terms of what they are offered and who should provide it, and they will be happier with the health service, so the argument goes. This week has seen the publication of a survey by MORI that underlines this thesis and, among other matters, suggests that people want much more information to help them make their choices (p437). Alongside the survey, the Department of Health has also announced that there are now evidence-based guides provided by the BMJ to surgical procedures and treatments available for a whole range of conditions through the NHS Direct website (p437).
These developments beg a number of questions. Does giving patients greater
choice actually improve health outcomes and is widening choice the most
equitable way to use limited NHS resources, or is it just a sop to those
people who still bother to vote in general elections?
We have all been daunted by the display on a supermarket aisle and overwhelmed
by the choice available. This is not a trivial parallel. Some foods we
choose to buy because we are in a hurry, others we buy because we are
having a dinner party and yet others because we think they are good for
us. Similar considerations are pertinent in health care. Some people
might choose a laparoscopic intervention because they will not have to
stay in hospital so long; others might opt for traditional surgery for
the same problem because they think that it is more likely to work.
The concern is that all this choice might only benefit the middle classes,
who already are at an advantage because they can be pushy, they ask more
penetrating questions and learn to play the system to their own advantage.
Pharmacists may have done the same themselves.
But who is going to advise those young, asthmatic mothers who smoke because
they have calculated that it is cheaper than eating, or those overweight,
hypertensive
middle-aged men who supplement their diet of beer and chips with curry
and crisps and who fail to take their medicines regularly?
For greater choice to be equitable, everyone needs someone to interpret
the information available to suit their situation. If people were able
to shop in the company of a dietitian, they would be able to choose more
wisely than they do when faced with hundreds of products. Without a guide
to the choices in health care only a minority of NHS users might benefit;
the rest will be so overwhelmed they will take the line of least resistance.
Whether some pharmacists will find themselves taking on an official role
as patient advocate remains to be seen, but the Government, in addition
to making all this information available, needs to consider how patients
are going to navigate and really understand it.
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