So what makes for better healthcare?

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Key points

  • The “best” treatment depends on your situation and needs.
  • Your doctor should understand these, not just your diagnosis.
  • Sometimes the best treatment may be “wait-and-see”.
  • Understanding a little about statistics is good protection against mistreatment and overtreatment.

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.

Shared decision-making has been defined as “the process of involving patients in clinical decisions”

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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?