Sometimes doctors do know best

Civitas, 22 January 2009

So, the NHS Constitution has been released after almost a year of negotiations, at a reported cost of around £1 million of taxpayers’ money. Was it worth it? Will it really make a difference to patient care?

I can do little more than repeat the comments of Katherine Murphy of the Patient’s Association:
“We do not expect this document to make any difference to the care patients are receiving. The [Healthcare Commission’s] annual health check was supposed to drive up standards, and yet we see the same trusts rated as weak year after year.
The hygiene code was supposed to ensure cleanliness standards in hospitals, but over 50% of trusts assessed in 2008 failed to meet the required standards. There are, however, no penalties for failure.
Patients need to know what the duty in the new health bill, requiring NHS organisations to “have regard to the NHS”, will really mean in practice. For the NHS constitution to be effective, trusts need to do more than “have regard” to it.
The time for NHS management to manage as if their jobs depended on it is long overdue. The time for words like safety, quality, choice and, in this case, constitution to have the meaning they have elsewhere in life is also long overdue.”
What is of more concern, however, is the way in which Alan Johnson chose to sell the document. ‘The end of the era of doctor knows best’. This makes no sense. I know what he’s getting at; and, of course, it is vital that doctor’s involve patients in decisions, take account of their personal circumstances and respect their concerns and preferences. As the GMC guidance says.
But, I’m sorry, if I’m sick and go to the doctor, I’d like to think that through years of training in medical school, the Foundation Programme, run-through training and the duty to keep professional knowledge and skills up-to-date, they might just know best about medicine and the diagnosis and treatment of illness.
In reality ‘the end of the doctor knows best’ serves as a convenient rationale for ‘government knows best’. There is no meaningful ‘patient power’ in the NHS; and nor will there be while the government controls the purse strings.