‘We doctors work in a climate of fear’ (Times)

This article, with its accompaniment Why doctors must ‘jump through hoops’, raises some very important points about the medical profession. Is it necessarily so bad to have guidelines set down as to the best treatment for any given condition, with these guidelines being based on firm evidence as opposed to the practicioner’s previous experience?

If everything was simple, and patients fit into neat boxes, then of course guidelines are helpful. But they cannot cover every scenario, and there will be occasions when following the guidelines is not in the best interest of the patient. For this to open up the possibility of litagation is absurd. There are always going to be cases where the doctor genuinely does know best, and most doctors will always try and act in the best interests of their patients. The growing climate of ‘Give x to treat y’ is not terribly helpful, and appears (to me) to be driven by the vast increase in non-medically trained managers within the NHS. They want to be able to plan expenditure down to the last penny. If they know that every patient who comes in with x will get y, this is made considerably easier. And, of course, in other industries (from which many of these managers are recruited) the situation really is this simple.

Whilst I would agree that it’s best to rely on evidence where evidence is available, the prevlance of Evidence Based Medicine should not be allowed to grow to such an extent that doctors work in a climate of fear, where they no longer feel free to do the things that they judge to be in the best interest of their patient.