Recently, a friend of mine had reason to have an appointment at a hospital for a heart test. The doctor had given a preliminary diagnosis and then referred him on to a specialist at the hospital. A perfectly normal and expected procedure for a doctor, it seems.
Things were not, however, that simple. What really happened, thanks to that most media-friendly of buzzwords ‘choice‘, was that my friend was given a sheet with the names and addresses of 6 different heart clinics1 and asked to choose which one he’d like. Naturally, the doctor couldn’t accept a choice there and then; he had to call a number (freephone, at least), give them his decision, then be passed on to the correct department to make the appointment. This was seven or eight weeks ago, and the government has decided that this is not enough - even more choice is needed in healthcare.
Choice is such a wonderfully convenient term after all, everyone wants choice, don’t they? When you’re presented with a list of hospitals by a doctor without any means of deciding which is most appropriate for you, though, the whole concept suddenly falls apart. In situations like the above, there’s no reason for any of us to make a choice. The way it should work seems pretty obvious to me – the doctor should say ‘I’ll book you an appointment at [insert name of most appropriate clinic here]. Is that okay, or do you need me to find you somewhere else?’ We’re simultaneously given a recommendation and the opportunity to make a different decision if we feel it’s necessary. My guess is that in 90% of cases where a choice is given to a patient, they either stick in the proverbial pin, perhaps just picking the first option on the list, or they ask the doctor for a recommendation anyway.
This is the problem of being given choice. What it really does is take the responsibility for ensuring we get the best healthcare away from the ever-more-impotent doctors. Most people want healthcare: whichever healthcare is best for them. Giving them a choice by default is giving them the opportunity to make the wrong choice. I’m not saying the NHS should inflexibly make all our decisions for us, far from it. I’m saying that they should give a recommendation first, and then offer us the opportunity to decline if we have to.
Choice for the sake of choice is just playing politics.
- the two local hospitals, three specialists in various nearby villages and one hospital in Nottingham [↩]
I can think of a few situations where choice is useful. One is where the patient would prefer to be at a hospital near to a relative or friend who lives many miles away, another where a patient has a history and knows a particular doctor or hospital. The patient might also have moved out of the area and wants continuous treatment from their previous doctor.
But I wouldn’t have a clue who to choose if I needed specialist treatment and, as you say, would have to rely on my GP to recommend the best clinician.
Tizzy
June 30, 2008 at 4:20 pm