12 – So what makes for better healthcare?

In this Chapter:

• Introduction (this page)
• What might the ideas in this website look like for you?
• Shared decision making: a consultation for a common condition
• Questions about translating research evidence into practice
  • 1: Isn’t anything worth trying when a patient has a life-threatening condition?
  • 2: Although patients might want to know if a treatment ‘works’, suppose they don’t want all the details?
  • 3: Statistics are confusing – should patients really have to look at the numbers?
  • 4: How can someone know that the research evidence applies to them?
  • 5: Won’t genetic testing – and ‘personalized medicine’ – mean doctors can work out the specific treatment needed in every individual and make all this unnecessary?
  • 6: If someone has a condition that is being studied in an ongoing clinical trial, how do they find out about this if their doctor doesn’t know about it?
  • 7: What’s the best way of telling if the evidence (on the web or elsewhere) is reliable?
  • 8: Are there reliable sources of information that can be recommended?
  • 9: How should people avoid being ‘labelled’ with an ‘illness’ and getting unnecessary treatments?
• Where do we go from here?
• References (Chapter 12)

Introduction

In the preceding sections we have drawn together many examples to illustrate why treatments can – and should – be based on sound research designed to address questions that are important to patients. Whether we are members of the general public, patients, or healthcare professionals, the effects of treatments touch the lives of all of us one way or another. Robust evidence from fair testing of treatments really does matter.

In this section we look at how such evidence can shape the practice of healthcare so that decisions about the treatment of individuals can be reached jointly by clinicians and patients.

Good decisions should be informed by good evidence, which will tell us about the likely consequences of different treatment options. However, the meaning and value of those consequences will be different for different individuals. So, using the same evidence, one individual may reach a different decision from another.

For example, a fully functioning finger may mean a lot more to a professional musician, a good sense of smell to a chef, and good eyesight to a photographer than they would to other people. They may therefore be prepared to make greater efforts or take greater risks to achieve the result that matters to them.

The interface between evidence and decisions is complex, so most of this section will address some common questions on this issue. However, before that, we consider ‘shared decision making’ more closely and illustrate what it might look like in practice. Sharing decisions in this way steers a middle course between professional paternalism and abandoning patients to make up their own minds alone. Patients regularly complain about lack of information yet, quite naturally, they have different expectations of the responsibility they want to accept. [1, 2]

Some patients prefer not to have detailed information about their illness and treatment options and would rather leave things entirely to their professional advisers, but many are keen to learn more. For those who would like more information, there should be ready access to well-written material and to skilled health professionals who can advise how and where they can access it in a format that best suits them.

What constitutes an ‘ideal consultation’ can differ widely from one person to the next. Some people are content to adopt a dependent role while others prefer to lead. A more participatory role in coming to a decision – with the doctor’s encouragement – can be the most rewarding approach and can become the preferred option once a patient experiences how this works. A simple question from a patient can open up the dialogue, as we illustrate here. Importantly, patients can be led to feel involved in their care when they are treated as equal partners, whatever the level of involvement.

Next: What might the ideas in this website look like for you?