Wales

Choosing Wisely aims for doctor-patient 'culture shift'

Dr Finlays Casebook
Image caption 'Doctor knows best' - Dr Finlay's Casebook, medical drama from the 1960s, depicted a traditional doctor-patient relationship

Patients in Wales are being urged to take more control of decisions about the care and treatments they receive, as part of a new medical movement.

Choosing Wisely Wales aims for a more equal doctor-patient relationship.

It comes amid worries up to 20% of treatments at best do no good but at worst could harm patients - something a top doctor has called "clearly unacceptable".

But there are fears the move might be interpreted as an effort to cut costs.

Those behind the movement, which already operates in 18 countries, want clinicians to have "open and honest conversations" about treatments, and say patients should be less passive, have more input and explore all alternatives.

Central to the idea are four questions a patient needs to ask:

Image copyright Thinkstock

Dr Paul Myres, programme leader and chairman of the Academy of Medical Royal Colleges in Wales, said: "Amazingly, I think in Wales in particular there's still the idea that 'doctor knows best' and, interestingly, some clinicians who come to work here say patients are that little more passive, not so assertive.

"We're encouraging them to be a bit more questioning in discussions with their clinicians."

It has been argued that if patients have "greater ownership" of the care they receive, they are more likely to follow a course of treatment, reject treatments that have little benefit, and may be less likely to return to the doctor.

The approach, it has been argued, could also lead to significantly better results for patients.

Dr Myres admitted "there was likely to be reluctance on both sides" and said the approach could be interpreted as an attempt to save money.

"It's not about cost-cutting, it's about reducing waste," he said.

"If something is wasted on a patient, then a person who really needs that treatment could face a delay."

It is also hoped the approach could help reduce the number of "unnecessary tests and treatments", which could result in shorter waiting times for patients with a genuine need.

This could include patients demanding antibiotics for colds and sore throats or those expecting scans for basic back pain.

But it could also involve serious diseases such as cancer, where patients might feel under pressure to accept invasive treatment which could leave them with a worse quality of life.

WHAT DO PATIENTS THINK?

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Media captionThese patients in Prestatyn had different views on the doctor-patient relationship

John Skipper, a retired serviceman, was formerly on the board of Community Health Councils in Wales. In 2011, aged 60, he was diagnosed with prostate cancer, which he described as "a wake up call".

"I needed to know more about my condition, I needed to know what might be the best outcome for me and be part of a team looking after me and not be on the outside looking in," he said.

"With cancer there are many interventions possible and some carry more risks than others. Removing the prostate gland can have some real side effects.

"I was talking with my consultant and with other professionals about what other options were available to me.

"They found that useful and for me it took away a lot of the stress and I felt empowered and part of the team looking after me."

Image caption John Skipper had dialogue with doctors about the options for his prostate cancer treatment

He said the Choosing Wisely concept meant patients were part of their own care.

"It enables the doctor to do what they're trained to do. You're guiding them to an option that they can perform, but at least you can say 'this is what I would prefer'," he said.

"We often have that discussion about our car when we take it in for a service, so why can't we have that discussion about our body?

"I think this whole culture has to be win-win for the NHS. It's not a bottomless pit of money but it has capability and it's about optimising the capability you have and dealing with realism."

Image caption Physiotherapist Graeme Paul-Taylor said giving every patient with back pain a MRI scan was not the answer

WHAT DOES THE MEDICAL PROFESSION THINK?

Graeme Paul-Taylor, a physiotherapist and lecturer at Cardiff University, has a lot of experience working with patients with lower back pain.

He said there was a growing belief that sending people for a MRI scan was the "gold standard" to provide all the answers.

"What's important is to exercise and to get moving and for a lot of people that gets them the results they need," he said.

"But over the last couple of decades, with the real quality and sensitive scanning and imaging that can be done, people are starting to believe that the structural changes that are seen on a MRI scan are the cause of the pain.

"We know if you were to scan people with no symptoms of back pain you're still likely to see those changes."

Dr Ffion Williams, from Prestatyn, Denbighshire, said the initiative was all about sharing information with patients.

"It's allowing people to make their own decisions so we're a conduit for information. It's not the old system that we're the doctor and 'you do what we tell you'," she said.

"Sometimes it's going to be a decision from a patient that I'm not going to agree with but it's also allowing the patient to make the decision but knowing they've had the right information to make it."

Dr Myres, a former Wrexham GP, concedes consultation times may need to be lengthened.

"Really good conversations need more time up front - even though research suggests actually it can be done in 10 minutes," he said.

"But the payback is if a patient fully understands and is involved in the decisions, they are more likely to comply and less likely to come back."

Choosing Wisely Wales is the first campaign of its type to be launched in the UK and is being led by the Academy of Medical Royal Colleges Wales, in partnership with Public Health Wales and Community Health Councils.

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