If you could take a cocktail of drugs for the rest of your days, which might save your life but could also offer side effects while not achieving much, what would you do?
This question seems pertinent now as the medicalisation of society is back under the microscope.
Leading doctors from the Academy of Medical Royal Colleges (AMRC), which represents some of the UK’s most eminent physicians, issued an unprecedented criticism of unnecessary scans and treatments earlier in the week.
The 40-strong list of unnecessary treatments includes plaster casts for children with small wrist fractures, which can heal themselves, x-rays for lower back pain and blood tests to diagnose the menopause, if the woman is older than 45 and suffering typical symptoms.
The conversation is starting to turn in this direction as times get harder, as financial pressures start to bite and medicine struggles to cope with its own success at helping people to live longer.
Scotland’s Chief Medical Officer Catherine Calderwood has led the way by asking doctors to embrace a culture of ‘realistic medicine’ in her annual report at the beginning of the year.
Among the tenets of this new doctrine are a reduction in unnecessary treatments and a rejection of the old “doctor knows best” adage, so patients are asked to discuss the kind of treatments they want.
It is an idea as old as the hills, yet at the same it is also a major change to how the NHS is run.
Patients expect “a pill for every ill” as society increasingly becomes more consumer driven and more focused on instant gratification.
This expectation means doctors have to buy into the idea, to a certain extent, as just telling someone to do some more exercise or quit smoking does not always satisfy their fears, even if it is the best solution.
One in five adults in Scotland takes more than five medications daily, which increases the chances of unwanted side effects and a significant risk of harmful consequences such as falls, confusion and hospital admission, according to Dr Calderwood’s annual report.
Critics suggest that ideas such as “realistic medicine” and Italy’s “slow medicine” are an excuse to ration services but this is a simplistic way of viewing things.
Just because doctors can do something, it doesn’t mean that they always should.
I have written before about palliative care and the importance of choice around someone’s last days and hours.
Discussions on unnecessary treatment and what patients should expect could help us to apply these ideas to the wider NHS, which is so clearly ailing.
At a conference in Edinburgh this week, Dr Calderwood told a story about how doctors had struggled to treat an elderly man with a lung condition called “bird fancier’s lung”.
The condition, which is leaves him breathless and damages the lungs, is caused by spending time in close proximity to bird droppings.
No matter what his doctors told him, the man would not give up his hobby of looking after pigeons.
When a doctor finally came to his house to speak to him, the daughter took him out into the garden to see sheds full of hundreds of pigeons and a room full of trophies from when the man had been one of the UK’s top pigeon racers.
Sometimes people have different priorities to what the NHS expects them to.