On Thu, 22 Mar 2001, John Platt wrote:
> I think that government policy and initiatives . . .
> in this as in many other areas of health care they are
> pinning a lot of hope on the notion of the informed, consumer orientated,
> patient as the driving force.
> The following is an example from the NeLH
> "In the 21st century patients will have unparalleled access to medical
> knowledge and the amply informed patient will be the major driving force
> for change in the health service."
> When patients turn up at their G.P.s surgery with the latest evidence
> (which a number of letters on a range of discussion lists suggests is
> starting to happen) then I suspect even the sceptics will find it necessary
> to re-address the principles of evidence-based-practice.
I think EBM cannot possibly succeed without some general understanding of
its basis among patients (which BTW certainly does not exist now in the
US). As Bernard Shaw said, "Doctors must believe, on the whole, what
their patients believe . . . when the patient has a prejudice the doctor
must either keep it in countenance or lose his patient. .. If [the doctor]
gets ahead of the superstitions of his patients he is a ruined man."
Patient preferences, however, can be shaped by doctors (more effectively I
suspect in a public forum than in the consulting room), advertising, fads,
etc., in both desirable and undesirable directions.
Until patietns have some understanding that more medical
care/tests/treatments are not intrinsically and always "good things", they
will feel deprived by any hesitation to recommend the maximal amount.
regards,
Anne Peticolas
Austin, Texas
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