Michael Kelly: Trust the professionals when it comes to health
THE case of Neon and Sally Roberts suggests we should give way to expert opinion when it comes to life and death decisions, writes Michael Kelly
Doctors know best. That’s the rule of thumb sick people should follow. Medical training in the UK is among the best in the world. The systems of registration and regulation are strict and independent. There is overwhelming evidence in the performance statistics of British doctors that they are competent, efficient and careful. The constant monitoring of outcomes, mortality, infection rates and other measures of success ensure that best practice can be spread from department to department from hospital to hospital and from trust ot trust.
The National Institute for Health and Clinical Excellence (NICE) “supports healthcare professionals and others to make sure that the care they provide is of the best possible quality and offers the best value for money”.
Scientific evidence is published on conditions from acne to whooping cough. In Scotland, this work is supported by that of the Scottish Intercollegiate Guidance Network (Sign) currently engrossed in the intricacies of “managing bacterial urinary-tract infection in adults” if that is not too much information.
All of this and more is overwhelming proof that doctors work to high science-based levels of competence – that the medical profession can and should be trusted. It is the reason we must firmly reject claims by patients, their relatives and non-qualified advisers to know better.
It is why the protestations of mothers such as Sally Roberts must be sympathetically but firmly ignored. She is the mother of Neon, her seven-year-old son who has just had a brain tumour removed. She is opposed to the recommended follow-up treatment which involves radiotherapy.
Admittedly Ms Roberts is in a heartbreaking position. She knows radiotherapy can damage the brain and could well leave her son mentally impaired. But doctors know that, in general, without the additional treatment the boy’s cancer is likely to return, this time fatally. Relying on their own experience and on scientific evidence they have concluded that, on the balance of probabilities, treatment is the best option.
The mother, on a hunch – it can’t be anything else – wants to take the poorer chance. She further displays apparent ignorance by wishing to subject her son to holistic therapies – therapies that see spiritual wholeness as the key to physical well-being. Whether this is to be homeopathy, hot stone fusion massage, Indian head massage or bioeletricmagnetic energy fields – or the latest crank theory – we are not told.
What we do know is that there is no evidence whatsoever that any alternative medicine works (except possibly as a placebo). If there was, these therapies would be in use in every doctor’s surgery. Restricting treatment of this boy to these remedies is an invitation to his cancer to return.
Mothers do not have any particular insight into the diagnosis, prognosis and treatment of their children once it goes beyond the common cold.
When doctors do make mistakes or systems break down – and these faults will occur in medicine as in any other walk of life – the safeguards are sufficiently robust to ensure that the errant parties are called to account and procedures improved to prevent reoccurrences.
This week saw the suspension for one year of a surgeon who it was found was not only unqualified to perform breast surgery but who was ruled to have dealt with his patient in a brusque and inconsiderate manner. Such a verdict opens the way for compensation in the civil courts for the woman so cruelly treated. Further inquiries may well be advised to discover how a medic whose interests were in colorectal surgery was allowed to perform a wider role at Aberdeen Royal Infirmary.
Such cases – rare as they are – do sap the public’s confidence. These abuses, understandably but unfairly, get far more publicity than the thousands of procedures properly performed. It is, therefore, in the profession’s own interest to ensure that the competence of doctors and the effectiveness of the supervision over them remain high. Medical training has seen great changes over the past 20 years. Students now see as much of patients as they do of textbooks. The medical side is well taken care of.
But as society continues to demand more empathy from all professions and businesses – to insist that they are customer-facing – training in the personal relations side of medicine may need more attention. Doctors will tell you that they do become inured to suffering. They can walk through accident and emergency units indifferent to displays of pain from patients waiting in triage because they know that more serious cases are being dealt with as priorities. They must not allow these reality checks to lead to their treating people as numbers rather than individuals.
And they must be aware that standards are rising.
This week, Professor Mary Ann Lumsden, a gynaecologist at Glasgow Royal Infirmary, contributed to new NICE guidelines for dealing with women who suffer early miscarriages. In the past, those pregnant women were dealt with less sympathetically than those nearing maturation. Clearly this has occurred because of improved techniques in preventing early miscarriage causing greater optimism of a successful pregnancy and greater distress in the case of failure.
It is reassuring to note that NICE has identified a problem and is suggesting additional training to rectify it. It is part of the overall commitment to keep standards high in the modern age.
Confidence in our health services extends beyond narrow medical decisions. It extend beyond thoughtful care, It extends to the area of patient confidentiality. The aftermath here of the hoax call about the Duchess of Cambridge should be a review of hospital protocols regarding all phone enquiries. Hospitals point out that even to confirm that a patient has been admitted breaches his confidentiality. Wards are daily subjected to calls from individuals claiming to be friends, colleagues or relatives when they are just nosey neighbours. Like one call last week from a women claiming to be the patient’s mother to which the alert nurse replied, ‘Oh, that’s not her sitting at the bedside?’, which, of course, in itself was going a bit too far. It’s a difficult one to discover a process that does not appear to be over-bureaucracy run by jobsworths but given the extreme tragic consequences of this one case demand an equitable solution.
Medicine is too important not to be left in the hands of doctors. In this country, we have the trained professionals, the well-run hospitals, the scientific evidence and the regulatory bodies to give all of us the confidence we need to trust the system.
Amateur opinion has simply no part to play.
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