Patient Choice – Is it what patients really want?

I’ve been intrigued for a while by the politicians voicing their opinions that we patients want choice from the NHS and that we are ‘consumers of healthcare’. Mr Hunt has been particularly vocal on the subject recently. Choice seems to be held up as a ‘Holy Grail’ by those designing healthcare policy.

I’m not sure that choice is what patients want at all. Obviously I write this from a personal perspective and cannot speak for all patients, but what I want when I am in patient role is a decent standard of healthcare delivered with compassion from somewhere fairly close to my home. I am extremely lucky to live only ten minutes drive from an Oncology centre. The Bexley Wing is a modern, well designed hospital environment which is probably about as comfortable as it gets in the NHS. I have sometimes thought to myself how much harder the past 18 months would have been on me and my family if we lived further away. Despite being a well informed patient I have never desired second opinions or treatment from other more specialist hospitals and have not exercised my right to choice personally.  

Healthcare cannot be compared to choosing the best deal on car insurance or scouring the shelves for bargains in the supermarket. Patients have a right to a good standard of care – which to me means safety combined with a good experience – wherever they are treated. Creating choice in some ways discriminates even more in my opinion. For example many of my patients are very frail and have cognitive impairment. Would these people choose to go to another hospital other than their local one because it may have a better reputation for treating their condition? ‘Choose and book’ is probably an alien concept to these patients, perhaps all they really want is their problems sorting out in a timely fashion without having to travel too far. I wonder how frequently people choose to be seen somewhere other than their local hospital and whether these people have any characteristics in common?

So instead of creating a consumer market would it not be better to invest in a patient safety culture and focus on patient experience to improve care for everyone everywhere? For Trusts that are succeeding to share their best practices with organisations that are struggling? This blog seems to ask a lot of questions, but I think this is because there are no easy answers to fix the NHS. However, I do think the politicians are so out of touch with what patients really want and how healthcare professionals really work that they do not really understand what they are trying to change.   

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4 thoughts on “Patient Choice – Is it what patients really want?

  1. I’m a patient with multiple chronic diseases which require specialist input and I want a choice of healthcare provider and a choice of medical treatments. In fact I want choice so badly, I travel abroad for medical treatment.

    As things stand, the NHS is like a lottery system. As a patient, you get referred to a local hospital which may or may not have a doctor who knows anything about your specific disease. Just because a doctor trained in a given specialty, it doesn’t mean they actually know very much about whatever disease you might have.

    You have no choice over the doctor you get to see, you are just assigned to someone. For one appointment you may see a consultant, at the next appointment you may see a junior, at the next appointment you may see a GPSI, then you might see a different junior. There is no continuity of care for patients and no choice.

    Because there is no continuity of care, doctors have no incentive to do a good job for you. You are nothing but a number on a file in a pile of files that they have to clear from their desk that day. They know they won’t see you again (because next time you’ll see someone else) so they don’t have to bother about getting to know your individual circumstances and how these impact on your disease management.

    Because these doctors have no incentive to build a relationship with patients over time, they can be brusque, dismissive, patronising etc. with no consequences. Lack of knowledge of the individual patients they are seeing, means that doctors easily stereotype patients (an “elderly woman”, an “unemployed man”) and make clinical and treatment decisions based on stereotypes rather than the individual’s circumstances, health status, preferences etc.

    When you are sent to different doctors all of the time, time-pushed doctors tend to rely on other doctors’ notes (that often contain inaccurate information – which can be dangerous) rather than retaking a history (which would provide valuable information) – again the patient suffers because they have no choice in who they see.

    Similarly doctors don’t have to provide a choice of treatments as they have patients over a barrel, it’s not like the patient can just easily choose to go elsewhere. Choice would mean that patients could speak with their feet. If a doctor provides a bad service, offers bad care or is rude or patronising, the patient could choose to go elsewhere. As it stands, all the power lies with doctors and patients have little say.

    It’s worth considering that while patients may be frail and elderly, they may well have family, friends or advocates who can speak up for them and help them choose a service. It doesn’t follow that because some people can’t benefit from choice, choice should be offered to no one.

    Also you have to consider that your experience of healthcare (as a doctor) is likely to be different to the average patient’s experience. If you mention that you are a doctor, you will get a better standard of care, perhaps you’ll be seen each time by the consultant (and not the most junior staff member), perhaps your consultant will fight that much harder to get you funding for that new treatment, perhaps the doctor will try harder to enroll you in a research study that might benefit you, perhaps you’ll not be treated in a dismissive, patronising manner, perhaps you’ll get a quicker referral etc.

    Other developed countries (I’m not talking about the US) offer choice to patients and their systems work well, have equivalent or better outcomes and don’t necessarily cost a lot more. It’s important to think about whose needs the NHS serves, doctors’ needs or patients’ needs?

    In an ideal world, everyone would get great care wherever they went. But sadly an ideal world doesn’t reflect the reality of systemic limitations, resource limitations and variation in personal factors such as individual doctors’ attitudes, motivation, knowledge and training.

  2. Great blog. A choice between private companies that so often employ our so-called public servants. Choice is one of those words that consistently raises my hackles. The myth of choice, a key word used as part of the marketing package for the Health bill.

  3. I entirely agree with this post. I have been perfectly happy with the care I have received from NHS GPs and both NHS and private consultants in the different towns where I have lived over the years. Oddly, I would probably be more concerned about choice If I were seeking plastic surgery or purely cosmetic treatment. But for the routine and sometimes serious illnesses I have experienced I have experienced, choice has never been an issue. Can you imagine worrying about choice if you are experiencing the symptoms of a stroke or heart attack?

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