Moneo writes: Strong constitution
At the end of September, the General Medical Council issued a document as part of its guidance on professional standards and ethics for doctors titled Decision making and consent, which comes into force at the beginning of November.
This is a very timely document as a member of my family has just received a letter from their GP practice informing them that a key element of their medication is to be changed to a cheaper version and this will allow the money saved to go into other areas of local healthcare. There has been no consultation or agreement and my family member is incredibly upset and says they have been made to feel guilty about wanting to stay with higher priced medication that they are happy with as, from what it says in the letter, this choice could well mean others being deprived of health care.
Unfortunately, this is not uncommon nowadays. Clinical Commissioning Groups decide unilaterally that action to save money will be taken whether it is in the best interest of the patient or not. As optometrists we have seen the same thing around, to name but one example, cataract referral thresholds. This type of action is reprehensible and is contrary to the NHS constitution.
I raise this subject in this month’s column because we all should know what the NHS constitution says for two reasons. Firstly, we are all NHS patients and it is therefore just common sense to know what the NHS pledges to provide to us. But, more importantly, this document makes pledges to patients on behalf of NHS clinicians and contractors pledging certain basic actions and rights that will be available to them. It is therefore vital that practising clinicians within the NHS, including us, need to be aware of what has been pledged on our behalf to ensure we do not fall foul of those pledges, thereby attracting a patient complaint.
While I would hope that we are all aware of our obligations under this constitution I suspect the majority of people reading this do not even know the document exists. I suspect it is for this reason the GMC has decided to remind its registrants of their responsibilities towards their patients when it comes to making decisions about care pathways and obtaining the patient’s consent for those actions.
The guidelines list seven principles of decision making and consent and I would like to highlight some of those here.
- Principle one: ‘All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.’
This may sound obvious, but how often do we alone decide what is best for our patients?
- Principle three: ‘All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.’
This is particularly relevant within optometry as well. Just how long do we as optometrists spend advising and giving our patients the knowledge they need to make informed choices. I often see appointment times of 20 to 30 minutes and wonder just how much time has been allowed within that consultation for the purpose of giving patients full information to allow them to make informed choices.
- Principle four: ‘Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.’
As optometrists we often make the assumption that what we decide upon is the best thing for the patient. How many times have we said to a patient something along the lines of ‘I’ve found something wrong with the back of your eye so I’m going to refer you for a second opinion’?
How long do we spend explaining to the patient what we have found and on what basis we will refer them and then what their choices are? Especially in the current times it may be that the patient chooses not to run the risk of being seen elsewhere due to their potential exposure to coronavirus and hence they need to be in full possession of the facts to make an informed clinical decision.
Finally, how many of us document fully the discussions we have had with our patients and the different modes of information we have provided them with and then recorded the patient’s desires in order to form part of their ‘informed treatment plan?’
It is interesting to note two comments at the start of the guidance: ‘This guidance is relevant to every health and care decision that you make with every patient. This includes decisions about treatments, procedures, interventions, investigations, screenings, examinations and referrals.’ And then, particularly relevant to us: ‘The guidance is addressed to doctors but may also be of interest to others.’
If we are to serve our patients fully and treat them properly, we need to treat them correctly and decision making and consent should be at the centre of that. How long will it be before the GOC adopts the same guideline?