Is choice always a good thing? Not always, especially when it comes to staff deciding what medical interventions they might need, says Dominic Howard, Director Europe, Best Doctors.
Choice can be a tyranny: the more choice there is, the more draining the decision-making process can be. There comes a point where you just want someone else such as an assistant or an eye-catching feature like a special offer to help make the decision for you.
This choice conundrum is about to come to one very important area – medical intervention.
For practically all of history, choice has been something most people haven’t wanted when it comes to being recommended what they should do when they’re ill. When most people visit their doctor, they want to be told what to do, or what to take. Six years at medical school must count for something, after all.
Which is why there was surprise when the Royal College of Surgeons (RCS) recently recommended that the role of doctors is no longer to tell patients which medical treatments they need to have, but to be presenters of a range of options so that people can decide for themselves.
The implication of this is that ‘doctor no longer knows best’. Given most ordinary people aren’t medical experts, and would consider themselves incapable of making such important decisions; the result appears to show that somewhat of an impasse has been created.
But has it? Or should there be other solutions to fill this void – like for instance, a second medical opinion?
Before answering this, it’s worth saying the sanctity of medical opinion has, in reality, been under the microscope for some time now. It’s a regular occurrence to find cases of families disputing the treatment they’re offered in favour of other, often experimental, options elsewhere. It’s a trend that’s been accelerated by the internet, where people are looking for other solutions to what they might see as the limited options placed before them.
While these people are sometimes labelled ‘cyberchondriacs’ for fearing the worst by reading non-peer reviewed material, it reflects a shift in the loci of consent from doctors to patients. This trend has been underscored by a fact that hospitals are increasingly being sued for taking the so-called ‘wrong’ course of action. In essence, RCS’ comments are a logical extension of the trend.
It’s also worth noting that people’s preferences do matter; some might seek out quick-fix surgical solutions while others gravitate to less invasive options, and the choices people are given reflect this. There is the undeniable fact too that medicine does actually sit on a spectrum, where there are a number of ‘right’ solutions, especially if people’s personal preferences to types of intervention are taken into account.
So, where do the RCS’s recommendations leave us? Being given too many options could, I believe, be a bad path to go down. Most people are, after all, lay individuals, and they cannot be expected to process lots of highly complicated medical advice themselves.
However, what the recommendations do imply, to doctors as much as their patients, is that there is demand to defer to a wider pool of people, and this does open an opportunity for second medical opinion. If doctors are now to offer a range of solutions, patients will want greater certainty about the nature of treatment they choose. A second medical opinion, provided it comes from the best medical minds, will, we believe, help people navigate their treatment choices in a much more informed way.
In the same way people want like-minded people to rate holiday destinations, Airbnb rooms and other products for sale, the shift from trusting a single expert to a larger set of peers is becoming more established. So it’s only natural to assume people will seek some extra safety valves when weighing up their own medical options.
It’s a fact that second medical opinions can change initial diagnoses and treatment suggestions. Some 17% of second medical opinions conducted by Best Doctors have resulted in a re-diagnosis, while 35% of patients are recommended an alternative course of treatment. That’s not to say the initial advice was always wrong; it’s more a case of a different medical process being followed. And surely that is not a bad thing?
Second opinion is another set of eyes taking a look, and in a world where people are going to have to make more decisions about their own courses of treatment themselves, they want reassurance they’re making the right one.