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Ian Kennedy comments (Patients are experts in their own field, BMJ,
2003; 326:1276-77) that ‘A mature culture will settle on sharing power and
responsibility, on a subtle negotiation...between professional and patient
as to what each wants and what each can deliver’.
But how will clinicians and health policy makers react to patients
who want the least effective treatment, which may also be less cost-
effective for the health service in the longer term? The potential for
this scenario arising has been indicated by the results of our pilot
survey of angina patients’ preferences for treatment for coronary artery
disease. Patients’ views on the range of invasive to less invasive
treatments were diverse. However, while surgical treatments (e.g. coronary
bypass surgery) were generally perceived to be ‘effective’, they were also
described by respondents in very negative terms, including ‘invasive’
and ‘frightening’, to be avoided altogether or delayed until they became
unavoidable (i.e. until the condition becomes life threatening). This
attitude was particularly prevalent in women and in older patients (aged
75 and over). A larger study, including the modelling of the results on
health care costs and outcomes, is required next, but the consequences for
the NHS of large numbers of patients opting for treatments other than
those that are clinically indicated need thinking through.
Ann Bowling, Professor of Health Services Research, Department of
Primary Care and Population Sciences, University College London, NW3 2PF
and MRC Health Services Research Collaboration, Bristol, BS8 2PR
Gene Rowe, Senior Research Scientist, Consumer Sciences Group,
Institute of Food Research, Norwich, NR4 7UA
Nigel Lambert, Acting Director, Consumer Sciences Group, Institute of
Food Research, Norwich
NR4 7UA
Shah Ebrahim, Professor of Epidemiology of Old Age, Department of
Social Medicine and MRC Health Services Research Collaboration, University
of Bristol, BS8 2PR
Richard Thomson, Professor of Epidemiology and Public Health, School
of Population and Health Sciences, University of Newcastle on Tyne, NE2
4HH
Michael Laurence, General Practitioner, Norwich, NR2 3QX
Jamie Dalrymple, General Practitioner, Norwich, NR12 7NL
Competing interests:
None declared
Competing interests:
No competing interests
30 June 2003
Ann P. Bowling
Professor of Health Services Research
Gene Rowe, Nigel Lambert, Shah Ebrahim, Richard Thomson, Michael Laurence, Jamie Dalrymple
Department of primary Care and Population Sciences, University College London (Royal Free), NW3 2PF.
Expert patients and patients' preferences:Expert patients BMJ 2003; 326 issue.
Expert patients BMJ 2003; 326 issue.
Patients' preferences for treatment
Ian Kennedy comments (Patients are experts in their own field, BMJ,
2003; 326:1276-77) that ‘A mature culture will settle on sharing power and
responsibility, on a subtle negotiation...between professional and patient
as to what each wants and what each can deliver’.
But how will clinicians and health policy makers react to patients
who want the least effective treatment, which may also be less cost-
effective for the health service in the longer term? The potential for
this scenario arising has been indicated by the results of our pilot
survey of angina patients’ preferences for treatment for coronary artery
disease. Patients’ views on the range of invasive to less invasive
treatments were diverse. However, while surgical treatments (e.g. coronary
bypass surgery) were generally perceived to be ‘effective’, they were also
described by respondents in very negative terms, including ‘invasive’
and ‘frightening’, to be avoided altogether or delayed until they became
unavoidable (i.e. until the condition becomes life threatening). This
attitude was particularly prevalent in women and in older patients (aged
75 and over). A larger study, including the modelling of the results on
health care costs and outcomes, is required next, but the consequences for
the NHS of large numbers of patients opting for treatments other than
those that are clinically indicated need thinking through.
Ann Bowling, Professor of Health Services Research, Department of
Primary Care and Population Sciences, University College London, NW3 2PF
and MRC Health Services Research Collaboration, Bristol, BS8 2PR
Gene Rowe, Senior Research Scientist, Consumer Sciences Group,
Institute of Food Research, Norwich, NR4 7UA
Nigel Lambert, Acting Director, Consumer Sciences Group, Institute of
Food Research, Norwich
NR4 7UA
Shah Ebrahim, Professor of Epidemiology of Old Age, Department of
Social Medicine and MRC Health Services Research Collaboration, University
of Bristol, BS8 2PR
Richard Thomson, Professor of Epidemiology and Public Health, School
of Population and Health Sciences, University of Newcastle on Tyne, NE2
4HH
Michael Laurence, General Practitioner, Norwich, NR2 3QX
Jamie Dalrymple, General Practitioner, Norwich, NR12 7NL
Competing interests:
None declared
Competing interests: No competing interests