In a BMJ article about personal health budgets, the chair of the Royal College of General Practitioners in the UK, Clare Gerada, says
“Should we be spending taxpayers’ money in cash strapped systems on gardening or aromatherapy that may make people feel better, but for which there is no evidence that it actually makes them better?”
This statement is a great example of the power issue at work in the practice of Medicine. The issue of personal health budgets is about the extent to which patients should be given the power to decide about what health care they want to receive. Dr Gerada uses this term “actually makes them better” – what does that mean? If someone who is suffering from a chronic incurable disease (and which chronic diseases are “curable”?) presents with terrible pain, or incapacitating fatigue, or paralysing anxiety, then what exactly is the definition of “better” – is there a “real” better and a “pretend” better? Surely, only the person themselves can tell whether or not their suffering is less, and only the person and their friends and family can tell if that person is now living a “better” life?
This use of “actually” is typical of doctors who reduce illness to lesions. They are thinking about someone who has less pain, but has no change in their underlying pathology – their MS plaques for example. Is that a sensible way to think about illness and health care?
There is a struggle going on, and it’s a power struggle. There are “experts” who think they are the only people who know what is best for patients. I don’t agree with them. If you ignore what the patient is telling you, if you ignore the “evidence” of the person’s life, then you’ve lost the plot!
Patient centred care means putting the patient at the heart of the care – not ignoring them or dismissing their reports of what is helping because “the evidence” doesn’t agree with this patient’s experience.