Monday 27 January 2014

Are patients less deserving of good care if they don't make a fuss?

Last week Professor David Haslam, the head of the National Institute of Health and Care Excellence (NICE), the body that governs which drugs to license for NHS use, said UK patients should become more 'American'. The idea being that we are too easily pushed around by our doctors and instead we should see ourselves as "equal partners" with our doctors and demand access to drugs we are entitled to.

Haslam's belief that we should monitor what drugs doctors make available to us, could make individual patients scapegoats when duty-bound professional bodies are buckling under the pressure to provide equal care.

Having the confidence to challenge authority, researching the drugs available to you and understanding your medical condition are all abilities that are largely determined by the way we were bought up, the education we have had and the social support network we have around us. Not everyone can afford the internet, not everyone feels confident to challenge people that are more knowledgeable than them and not everyone has other people they can turn to for help when trying to understand their medical condition.

There is also the irony, that those who are healthier could receive better care than those at their sickest, as sometimes patients are just too ill to be demanding and need to be completely reliant on their doctors to steer them through their illness. In this scenario, without a family member that can afford to take time off work to act as the patient's advocate, he or she may well find their care drops as they cannot cope with the responsibility thrust upon them by bodies such as NICE.

I'll always champion people taking control of their own health, because in the long-run I believe it helps improve both quality and quantity of life, but the NHS is a wonderful institution because it strives to provide equal care regardless of its patients' life experiences. As soon as it starts expecting patients to self-police the way our doctors treat us then we are heading down the road of widening health inequalities, where those who are weakest or have poorer access to support, resources and education will be sidelined in favour of patients who have learnt how to demand better care.

Haslam has said: “I think it is essential for the future of the health service and for the future health of the nation that patients understand their conditions, their treatments and work with their health advisors so they can have the best care." Behind this statement seems to be the threat, that in the not too distant future, patients who don't try hard enough to understand their medical condition will only have themselves to blame if their care isn't of the best standard.

NICE is currently carrying out work to find out why some patients cannot access drugs that it has endorsed. Haslam would do better concentrating on discovering the causes behind the post-code lottery for drugs, then trying to push for a future in which a patient must be made the scapegoat for a politician's failure to get to grips with providing standardised NHS funding and levels of care.