The GMC has recently revised its guidance on prescribing. Here’s the relevant paragraphs related to what a doctor is expected to do before they issue a prescription –
What can you expect from your doctor before they hand you a prescription?
February 16, 2013 by bobleckridge
3. For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication. Each person has a role to play in making decisions about treatment or care.
4. No single approach to discussions about treatment or care will suit every patient, or apply in all circumstances. Individual patients may want more or less information or involvement in making decisions depending on their circumstances or wishes. And some patients may need additional support to understand information and express their views and preferences
5. If patients have capacity to make decisions for themselves, a basic model applies:
a. The doctor and patient make an assessment of the patient’s condition, taking into account the patient’s medical history, views, experience and knowledge.
b. The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.
c. The patient weighs up the potential benefits, risks and burdens of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor, or for no reason at all.
d. If the patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.
What interests me most about this is that the GMC is absolutely clear that health care is a partnership. We often seem to deliver health care as if the expert knows everything and the patient knows nothing. But, in fact, the GMC expects that doctors will act more as expert advisors to enable patients to make their own choices, and that whilst the doctor does not need to defer to the patient’s choice, neither does the patient have to defer to this particular doctor’s choice.
This guidance is part of the shift in power, away from a paternalistic form of doctoring towards a humble servant model. Or am I reading too much into this?