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‘We doctors work in a climate of fear’


Hold up! Before you read on, please read this...

This post was published more than 15 years ago

I keep old posts on the site because I often enjoy reading old content on other people's sites. It can be interesting to see how views have changed over time: for example, how my strident teenage views have, to put it mildly, mellowed.

I'm not a believer in brushing the past under the carpet. I've written some offensive rubbish on here in the past: deleting it and pretending it never happened doesn't change that. I hope that stumbling across something that's 15 years old won't offend anyone anew, because I hope that people can understand that what I thought and felt and wrote about then is probably very different to what I think and feel and write about now. It's a relic of an (albeit recent) bygone era.

So, given the age of this post, please bear in mind:

  • My views may well have changed in the last 15 years. I have written some very silly things over the years, many of which I find utterly cringeworthy today.
  • This post might use words or language in ways which I would now consider highly inappropriate, offensive, embarrassing, or all three.
  • Factual information might be outdated.
  • Links might be broken, and embedded material might not appear properly.

Okay. Consider yourself duly warned. Read on...

‘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.

This 131st post was filed under: News and Comment.

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21st February 2007.

This post has been referenced by another on this site:
sjhoward.co.uk » Why the NHS really spends too much on drugs

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