Why doctors pick different options to those they offer patients – Dr Catherine Calderwood

Doctors sometimes assume patients with a terminal disease will want longer life above all else, but make different choices when in the same situation
Doctors sometimes assume patients with a terminal disease will want longer life above all else, but make different choices when in the same situation
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Patients need a greater say in their own treatment, writes Scotland’s Chief Medical Officer Dr Catherine Calderwood.

“How are you?” – a simple, routine greeting we use on meeting someone whether or not we know them.

We want to hear they are “fine” or to sympathise if life is not so good. Society values health in this everyday way as well as in more significant ways. But do we appreciate the gift of good health or only realise what we have lost when it’s gone – the lonely older person only visited when they are admitted to hospital, the regret of a life not fully enjoyed when significant illness is diagnosed.

Modern healthcare will be able to patch us up, cure the ills, facilitate the creation of new life, or will it? In some cases, yes – antibiotics can cure infection, pins and plates will mend a fractured bone. But in many other cases, the end result will not be the health that went before – drugs have side effects, hip replacements wear out, IVF may not work. Gloomy? Absolutely not. That we are living longer lives than ever before is a testament to improvements in healthcare. But would you want to live forever? A risky question perhaps to pose as the Chief Medical Officer for Scotland.

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I don’t know you personally or your current state of health, but perhaps take a few seconds to think about your answer to this question. As a doctor, the evidence shows that I may make some assumptions about your likely answer. Several studies have shown when doctors are asked what they think the priorities are for people who have been given a terminal diagnosis, they believe people will want to live as long as possible. Their offer of treatment is based on this belief. But when the patients are asked, they want two things: to be symptom-free and spend time with their families.

Other research tells me doctors make different decisions and choices for themselves than they offer their patients, often declining treatment. This disconnect disturbs me. Why might I make a different decision? I have to presume it is because I have more information about risks and side-effects and have experience of how a particular operation, intervention or medication can affect people. This is not the case for all our healthcare interventions but it is striking for some.

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I would like to become more realistic about the treatment and social care we offer people. You as individuals will all have answered my first questions differently – the consideration of what your state of health means to you, what if good health deteriorated and what your priorities would be if able to ‘live forever’. People are realistic in the main which is perhaps where my Chief Medical Officer report ‘Realistic Medicine’ came from. The recognition perhaps that one size will not fit all. Not everyone wants to be able to run a marathon, for a walk with the dog may be enough.

Realistic Medicine involves listening to patients, sharing decision-making between healthcare professionals and their patients, ensuring they have understandable information to make an informed choice. I want us to move away from the ‘doctor knows best’ culture to ensure a more equal partnership with people.

Catherine Calderwood is Scotland’s Chief Medical Officer and is on Twitter @CathCalderwood1