can then have a genuine conversation with the patient about that information, how it does/doesn’t apply to them, and fully discuss all the available options based on the level of knowledge that person has. Of course, some people have poor health literacy. A recent research figure I heard was that 49 per cent of UK working age adults do not understand the information in the bowel screening pack. Tis is something doctors must be aware of when explaining things, for example by avoiding jargon and double checking the patient has understood what has been discussed.
How do you foresee the process of informed consent changing? What I’m interested in is the way discussions around consent are framed, because clearly it is a legal process and that raises some difficulties. But it’s about patients knowing that it is their choice as to whether or not they go ahead with treatment. A surgical trainee approached me recently on the train and said he had read my report and had already changed the way he talks to patients when consenting for an operation. He now explains that they have the option not to go ahead with the surgery, that they don’t have to do anything at all. Just because we’ve got the intervention or treatment, doesn’t necessarily mean everything is right for every person.
Will doctors who (rightly) choose to “do nothing” simply end up facing more patient complaints? Tere’s definitely a perception that doctors could open themselves up to criticism for not giving enough treatment. But I’m hearing from health boards examples of complaints where a patient has had too much intervention, where the family have written aſterwards to say they died in a way that is not what they would have wanted. So perhaps doctors are worried when they shouldn’t be? It all comes back to shared decision making and personalised care. If doctors have a full, properly documented
SUMMER 2016
discussion with patients and their family about the available options, and then decide not to offer treatment with the patient’s consent, that doesn’t generate complaints, that generates thank you cards.
How can we move away from the “doctor knows best” culture to one of shared decision making? People who come into the health service now are generally much better informed. Oſten they have googled their symptoms beforehand and may have reached their own conclusions, sometimes wrongly. I would welcome that change. Te doctor
Are the changes proposed in Realistic Medicine achievable? I hope so. I’ve been talking to doctors across Scotland and what they’re saying is that this is the right way to go. Tey do not need to be persuaded, and are asking “what can we do to help achieve it?” Te conversations I’m now starting to have focus on implementation. Tere’s a lot of momentum behind the report; a lot of people are talking about it as an acceptable way to practice. So I think in Scotland, as a smaller country, perhaps it is more achievable here than it would be elsewhere. It’s about educating trainees to practise medicine like this, and also to make changes at a more senior level to ensure a supportive environment for those trainees as they progress in their careers. Te important thing is for everybody – not just doctors – to buy into this concept and to help make the changes a reality.
n Interview by Joanne Curran, associate editor at MDDUS
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