Wednesday, 4 February 2009

Patient choice - does it matter that much?

Such a thought! Not politically correct at all. I dare anyone to have it – particularly on a day Carol Thatcher was sacked by the BBC’s “The One Show”!

Establishing a partnership, informing people with risks or kidney disease, supporting them in turning that information into knowledge about their medical condition and listening to their views and aspirations are central to good medical care. So patient choice is paramount.

“Choose and Book” however has got a bad name, certainly in the medical community. Partly I think because of the implementation delays and problems, partly maybe because picking from a list without knowing what the menu says, looks like choice but isn’t really; but also, the clinical community, at times, fail to appreciate the concerns of our public. The recent National Patient Choice Survey shows that hospital cleanliness and low infection rates were selected most often (by 74% of patients) as an important factor when choosing a hospital.

Increasingly people are remarking to me that they have been given a choice – they ask where to go for their cardiology or urology appointment – the reputation of the service seems to be one of the most important things in making a decision. Infection rates are a key part of that reputation.

One of the things that often taxes me is trying to get a handle on the quality of choice that we offer people with advanced kidney disease. I was struck by the patients’ perceptions reported in the Study of Implementation of Renal Standards (SIRS) that Anu Trehan (now an Acute Physician, Salford Royal) showed, revealing that the vast majority of patients felt either that there was no choice of modality or that the doctor or nurse had made the choice. That was a study of over 1000 consecutive patients in the North West of England in the earlier part of this decade – all the services thought they were offering choice! If there isn’t a local dialysis unit or an assisted peritoneal dialysis service do people opt for conservative kidney care because of the need to travel to a distant dialysis unit? If there is no local home haemodialysis training team how do people get to hear about and choose this option? Do people really choose to go onto dialysis before they are put onto the transplant waiting list?