The move away from “doctor knows best” may be leading to GPs putting too much pressure on patients to make snap decisions about treatments, it is claimed.
NHS surveys have shown that people want to be more involved in their healthcare with shared decision-making considered best practice.
However, there is concern that patients are not being given adequate information from time-pressured doctors and a reliance on phone consultations may have exacerbated this.
Guidance by the UK National Institute for Health and Care Excellence (NICE) focuses on the importance of communicating risks, benefits, and consequences of interventions to patients
A health source in Glasgow said she was increasingly hearing from patients who felt “the onus was on them” to make decisions during 10-minute GP consultations.
In one case, a patient who said she would rather explore other options than take cholesterol drug statins was recorded as declining treatment with very little information or advice.
READ MORE: Health: Feel a cold coming on? Here's how to stop it getting worse
Dr Lynsay Crawford, a GP for 26 years who spent most of her working life in Possilpark in Glasgow, says this is “wrong”.
She said: “We are trying to move away from this paternalistic ‘doctor knows best’ attitude because society has changed and so has access to information, so people’s health literacy has improved.
“But it’s about shared decision-making and an informed choice. It’s not about, ‘you’ve made the decision and I can now write in the notes that you don’t want that’.
“That’s wrong, that’s not what is meant to happen. It should not be about putting the onus onto the patient.
“A GP consultation may last between 10 and 15 minutes. The clock starts the moment you walk along the corridor to get there. Realistically, to do it properly, it takes a lot longer.
“It may be easier to just write ‘the patient doesn’t want the statin’. I can understand the time constraints but that is not how I consult.”
Dr Crawford added: “Even if it is, here is some information for you and we can catch up with a phone consultation in a week
or so.
“Although there is easy access to information, patients don’t always know if it is evidence-based, valid information.
READ MORE: Doctors could strike for first time in decade over 'unacceptable' pay offer
“I get it a lot with HRT just now – thank you, Davina! There is an awful lot of misinformation and false expectations being raised that HRT is a wonder drug that will make you feel 21 again – it won’t.”
She said her consultations “always run over” because it is crucial to establish a rapport and persuade the patient that she is listening.
She said: “If I was making a diagnosis, I might say ‘You’ve got X, these are the ways in which we can treat it, what are your thoughts on that’. I take the time and I run late.”
A recent study, published by the BMJ, explores how language that belittles, infantalises, or blames patients can threaten the collaborative relationships the NHS is trying to foster.
“It’s things like ‘claims to have chest pain’ which has a nasty hint to it, rather than ‘the patient describes the chest pain they are having as very different’,” said Dr Crawford, who is a senior clinical lecturer at the University of Glasgow's medical school.
READ MORE: Issue of the day: The bid to boost alcohol drinking in Japan
“The patient you referenced [in relation to statins] must have left that consultation wondering how it was recorded. They didn’t decline statins, they wanted to explore other options.”
The Patients Association said it had concerns that time pressures were presenting as a barrier to shared decisions.
A professor of medical ethics and law at the University of Glasgow, Al Dowie, says there must be an individualised approach as some patients “prefer the doctor to be in charge”.
He said: “For reasons of consent, it’s common for doctors to encourage patients in actively making their own decisions on the available options, supported by giving patients the necessary information on pros and cons.
“If it’s not the patient’s own voluntary choice, then technically they haven’t given consent (even if they go along with it).
“There’s also a cautious avoidance of medical paternalism in this respect, where all the decision-making is in the hands of the doctor.
“Some patients, of course, prefer the doctor to be ‘in charge’, and part of the consultation is to gauge the extent to which patients want a shared decision-making approach.”
Dr Crawford advised patients to “think about what you want to get out of the consultation”.
She added: “It’s your body, it’s your life and it’s your health.”
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereLast Updated:
Report this comment Cancel